Organization
CHEYENNE MEDICAL SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MATTHEW MONGER MD (PARTNER OWNER)
(307) 772-8226
Entity
Organization
Contact information
Practice address
5050 POWDERHOUSE RD, CHEYENNE, WY 82009
(307) 772-8226
(307) 634-1271
Mailing address
5050 POWDERHOUSE RD, CHEYENNE, WY 82009
(307) 772-8226
(307) 634-1271
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1095
BLUE CROSS BLUE SHIELD
—
01
—
5300519664
CLIA
—
Enumeration date
12/05/2005
Last updated
12/28/2007
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