Provider Demographics
NPI:1184766909
Name:CONSULTANTS IN SURGERY PC
Entity type:Organization
Organization Name:CONSULTANTS IN SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAKE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:PULLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-632-1114
Mailing Address - Street 1:5201 YELLOWSTONE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4741
Mailing Address - Country:US
Mailing Address - Phone:307-632-1114
Mailing Address - Fax:307-632-9920
Practice Address - Street 1:5201 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4741
Practice Address - Country:US
Practice Address - Phone:307-632-1114
Practice Address - Fax:307-632-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW306155Medicare ID - Type Unspecified