Provider Demographics
NPI:1023553799
Name:NORTH CHEYENNE MEDICAL
Entity Type:Organization
Organization Name:NORTH CHEYENNE MEDICAL
Other - Org Name:NORTH CHEYENNE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SKAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-277-9424
Mailing Address - Street 1:428 S DURBIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2818
Mailing Address - Country:US
Mailing Address - Phone:307-337-4284
Mailing Address - Fax:
Practice Address - Street 1:6015 SYCAMORE RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4347
Practice Address - Country:US
Practice Address - Phone:307-514-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty