Provider Demographics
NPI:1235231028
Name:CHEYENNE KIDNEY AND DIALYSIS CLINIC PC
Entity Type:Organization
Organization Name:CHEYENNE KIDNEY AND DIALYSIS CLINIC PC
Other - Org Name:ASSOCIATES IN INTERNAL MEDICINE PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALPERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-635-9131
Mailing Address - Street 1:2301 HOUSE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3177
Mailing Address - Country:US
Mailing Address - Phone:307-635-9131
Mailing Address - Fax:307-637-8300
Practice Address - Street 1:2301 HOUSE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3177
Practice Address - Country:US
Practice Address - Phone:307-635-9131
Practice Address - Fax:307-637-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY05826001OtherBLUE CROSS BLUE SHIELD
CQ3266OtherRAILROAD MEDICARE
CQ3266OtherRAILROAD MEDICARE