Provider Demographics
NPI:1952487001
Name:WILLIAM C NEAL, M.D. PLLC
Entity Type:Organization
Organization Name:WILLIAM C NEAL, M.D. PLLC
Other - Org Name:OTHOPAEDIC 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 WEST BRAODWAY
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6102A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805302900Medicaid
WY05661001OtherBLUE CROSS BLUE SHIELD
WY120327400Medicaid
WY05661001OtherBLUE CROSS BLUE SHIELD
WYA49542Medicare UPIN
WY120327400Medicaid
WYDC3826Medicare PIN
WYW10365Medicare PIN