Provider Demographics
NPI:1093878837
Name:WESTERN MEDICAL AND NEUROSCIENCE
Entity Type:Organization
Organization Name:WESTERN MEDICAL AND NEUROSCIENCE
Other - Org Name:WESTERN MEDICAL ASSOCIATES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:N
Authorized Official - Last Name:FRARY
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:307-577-5100
Mailing Address - Street 1:1020 S CONWELL ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3921
Mailing Address - Country:US
Mailing Address - Phone:307-577-5100
Mailing Address - Fax:307-234-1201
Practice Address - Street 1:2546 E 2ND ST
Practice Address - Street 2:SUITE 600
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2062
Practice Address - Country:US
Practice Address - Phone:307-265-3737
Practice Address - Fax:307-265-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY05908002OtherBLUE CROSS CLINIC NUMBER
WYDE9288OtherRAILROAD MC GROUP NUMBER
WY05908002OtherBLUE CROSS CLINIC NUMBER