Provider Demographics
NPI:1578824801
Name:CHEYENNE REGIONAL URGENT CARE, LLC
Entity Type:Organization
Organization Name:CHEYENNE REGIONAL URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARBURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-633-7937
Mailing Address - Street 1:PO BOX 912491
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-2491
Mailing Address - Country:US
Mailing Address - Phone:307-773-8133
Mailing Address - Fax:
Practice Address - Street 1:433 E 19TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4643
Practice Address - Country:US
Practice Address - Phone:307-773-8133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care