Provider Demographics
NPI:1235640392
Name:CEDARS HEALTH
Entity Type:Organization
Organization Name:CEDARS HEALTH
Other - Org Name:CEDARS HEALTH CASPER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SKAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-337-4284
Mailing Address - Street 1:428 S DURBIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2818
Mailing Address - Country:US
Mailing Address - Phone:307-337-4284
Mailing Address - Fax:
Practice Address - Street 1:428 S DURBIN ST STE 104
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2818
Practice Address - Country:US
Practice Address - Phone:307-337-4284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDARS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care