Provider Demographics
NPI:1215561378
Name:WINDRIVER MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WINDRIVER MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:J
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-372-4282
Mailing Address - Street 1:2620 COMMERCIAL WAY STE 10
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4705
Mailing Address - Country:US
Mailing Address - Phone:307-372-4282
Mailing Address - Fax:307-382-4291
Practice Address - Street 1:2620 COMMERCIAL WAY STE 10
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4705
Practice Address - Country:US
Practice Address - Phone:307-372-4282
Practice Address - Fax:307-382-4291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty