Provider Demographics
NPI:1750540043
Name:SOUTHEAST WYOMING HEALTHWATCH LLC
Entity type:Organization
Organization Name:SOUTHEAST WYOMING HEALTHWATCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:BERGONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-214-1350
Mailing Address - Street 1:6867 SAY KALLY RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5734
Mailing Address - Country:US
Mailing Address - Phone:307-214-1359
Mailing Address - Fax:307-635-8486
Practice Address - Street 1:6867 SAY KALLY RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-5734
Practice Address - Country:US
Practice Address - Phone:307-214-1350
Practice Address - Fax:307-635-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No333300000XSuppliersEmergency Response System Companies