Provider Demographics
NPI:1457609935
Name:BIENE STAR CO
Entity Type:Organization
Organization Name:BIENE STAR CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-256-2155
Mailing Address - Street 1:6215 CLEAR CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-1951
Mailing Address - Country:US
Mailing Address - Phone:307-256-2155
Mailing Address - Fax:
Practice Address - Street 1:6215 CLEAR CREEK PKWY
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-1951
Practice Address - Country:US
Practice Address - Phone:307-256-2155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2345A207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty