Provider Demographics
NPI:1093902587
Name:TOM A NACHTIGAL MD FACS PC
Entity Type:Organization
Organization Name:TOM A NACHTIGAL MD FACS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:A
Authorized Official - Last Name:NACHTIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-745-8442
Mailing Address - Street 1:3125 E GRAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5137
Mailing Address - Country:US
Mailing Address - Phone:307-745-8442
Mailing Address - Fax:307-742-0036
Practice Address - Street 1:3125 E GRAND AVE STE B
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5137
Practice Address - Country:US
Practice Address - Phone:307-745-8442
Practice Address - Fax:307-742-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4490A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116885100Medicaid
WY311227OtherBLUE CROSS BLUE SHIELD WY
WY311227OtherBLUE CROSS BLUE SHIELD WY
WYE50025Medicare UPIN