Provider Demographics
NPI:1053822163
Name:CEDARS HEALTH
Entity Type:Organization
Organization Name:CEDARS HEALTH
Other - Org Name:CEDARS HEALTH RIVERTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SKAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-337-4284
Mailing Address - Street 1:428 S DURBIN ST
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:307-337-8284
Mailing Address - Fax:
Practice Address - Street 1:716 COLLEGE VIEW DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2282
Practice Address - Country:US
Practice Address - Phone:307-856-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDARS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine