Provider Demographics
NPI:1942388178
Name:CHEYENNE UROLOGICAL PC
Entity Type:Organization
Organization Name:CHEYENNE UROLOGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-635-4131
Mailing Address - Street 1:2301 HOUSE AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3179
Mailing Address - Country:US
Mailing Address - Phone:307-635-4131
Mailing Address - Fax:307-635-4134
Practice Address - Street 1:2301 HOUSE AVE STE 502
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3179
Practice Address - Country:US
Practice Address - Phone:307-635-4131
Practice Address - Fax:307-635-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110722400Medicaid
WYCT1864OtherRAILROAD MEDICARE
WY01045001OtherBCBS OF WYOMING
WYCT1864OtherRAILROAD MEDICARE