Provider Demographics
NPI:1366631285
Name:CHARLES G WELCH, P.C.
Entity Type:Organization
Organization Name:CHARLES G WELCH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-587-9800
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-1330
Mailing Address - Country:US
Mailing Address - Phone:307-754-3319
Mailing Address - Fax:307-754-2443
Practice Address - Street 1:1613 STAMPEDE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4710
Practice Address - Country:US
Practice Address - Phone:307-587-9800
Practice Address - Fax:307-587-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6582A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY125126100Medicaid
WYW21625Medicare PIN