Provider Demographics
NPI:1235274523
Name:WESTERN MEDICAL ASSOCIATES, L.L.C. DIAGNOSTICS AND IMAGING
Entity Type:Organization
Organization Name:WESTERN MEDICAL ASSOCIATES, L.L.C. DIAGNOSTICS AND IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FRARY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:307-577-5100
Mailing Address - Street 1:6500 E 2ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4321
Mailing Address - Country:US
Mailing Address - Phone:307-577-5100
Mailing Address - Fax:307-233-0610
Practice Address - Street 1:6500 E 2ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4321
Practice Address - Country:US
Practice Address - Phone:307-577-5100
Practice Address - Fax:307-233-0610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN MEDICAL AND NEUROSCIENCE ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
05908001OtherBLUE CROSS / BLUE SHIELD
WYDE9288Medicare PIN
WYW20606Medicare PIN