Provider Demographics
NPI:1922351063
Name:ARLENE VIRAY
Entity Type:Organization
Organization Name:ARLENE VIRAY
Other - Org Name:ARLENE VIRAY, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-235-2552
Mailing Address - Street 1:111 W 2ND ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2454
Mailing Address - Country:US
Mailing Address - Phone:307-235-2552
Mailing Address - Fax:307-237-5568
Practice Address - Street 1:111 W 2ND ST
Practice Address - Street 2:SUITE 305
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2454
Practice Address - Country:US
Practice Address - Phone:307-235-2552
Practice Address - Fax:307-237-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1128101YP2500X
WYLPC 276101YP2500X
WYLPC357101YP2500X
WY5753A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY111020900Medicaid
WY304008Medicare Oscar/Certification
WYF88465Medicare UPIN