Provider Demographics
NPI:1639783335
Name:ADVANCED SURGICAL CARE OF WYOMING, LLC
Entity Type:Organization
Organization Name:ADVANCED SURGICAL CARE OF WYOMING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-682-6222
Mailing Address - Street 1:51 TOWN CENTER DR STE 140
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5521
Mailing Address - Country:US
Mailing Address - Phone:307-660-3934
Mailing Address - Fax:
Practice Address - Street 1:51 TOWN CENTER DR STE 140
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5521
Practice Address - Country:US
Practice Address - Phone:307-660-3934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical