Provider Demographics
NPI:1275583965
Name:WESTERN MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WESTERN MEDICAL ASSOCIATES, LLC
Other - Org Name:WESTERN MEDICAL ASSOCIATES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
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 200
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
05908001OtherBLUE CROSS / BLUE SHIELD
WY121899900Medicaid
WY611665900OtherDOL CLINIC NUMBER
WYDE9288Medicare PIN
WY611665900OtherDOL CLINIC NUMBER