Provider Demographics
NPI:1215041611
Name:CHEYENNE HEMATOLOGY-ONCOLOGY SERVICES PC
Entity Type:Organization
Organization Name:CHEYENNE HEMATOLOGY-ONCOLOGY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-634-0233
Mailing Address - Street 1:421 EAST 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4609
Mailing Address - Country:US
Mailing Address - Phone:307-634-0233
Mailing Address - Fax:307-634-0234
Practice Address - Street 1:421 EAST 17TH STREET
Practice Address - Street 2:CHEYENNE HEMATOLOGY-ONCOLOGY SERVICES PC
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4609
Practice Address - Country:US
Practice Address - Phone:307-634-0233
Practice Address - Fax:307-634-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2661A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY310940Medicare ID - Type Unspecified