Provider Demographics
NPI:1720296130
Name:WYOMING SPINE AND NEUROSURGERY LLC
Entity Type:Organization
Organization Name:WYOMING SPINE AND NEUROSURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CCS-P
Authorized Official - Phone:307-778-2860
Mailing Address - Street 1:1950 BLUEGRASS CIR
Mailing Address - Street 2:STE 170
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7323
Mailing Address - Country:US
Mailing Address - Phone:307-778-2860
Mailing Address - Fax:307-778-2866
Practice Address - Street 1:1950 BLUEGRASS CIR
Practice Address - Street 2:STE 170
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7323
Practice Address - Country:US
Practice Address - Phone:307-778-2860
Practice Address - Fax:307-778-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6491A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE099175Medicare PIN
WY308624Medicare PIN