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Organization

WYOMING SURGICAL CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHARLES ROBERTSON (ADMINISTRATOR)
(307) 472-8781
Entity
Organization

Contact information

Practice address
4140 CENTENNIAL HILLS BLVD, #C, CASPER, WY 82609
(307) 472-8781
(307) 472-8887
Mailing address
4140 CENTENNIAL HILLS BLVD, #C, CASPER, WY 82609
(307) 472-8781
(307) 472-8887

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
08 012
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
116664600
WY
01
310945
BLUE CROSS BLUE SHIELD OF WYOMING
WY
01
490005195
RAILROAD MEDICARE
WY
Enumeration date
03/31/2006
Last updated
05/13/2008
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