Provider Demographics
NPI:1578751913
Name:WILLIAM C NEAL, M.D. PLLC
Entity Type:Organization
Organization Name:WILLIAM C NEAL, M.D. PLLC
Other - Org Name:ORTHOPAEDIC ASSOCIATES OF JACKSON HOLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-734-5999
Mailing Address - Street 1:PO BOX 7369
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-7369
Mailing Address - Country:US
Mailing Address - Phone:307-734-5999
Mailing Address - Fax:307-734-0345
Practice Address - Street 1:945 W BROADWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-7369
Practice Address - Country:US
Practice Address - Phone:307-734-5999
Practice Address - Fax:307-734-0345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM C NEAL, M.D. PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-11
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120327400Medicaid