Provider Demographics
NPI:1912101973
Name:CAROL A FISCHER MD PC
Entity Type:Organization
Organization Name:CAROL A FISCHER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-778-3121
Mailing Address - Street 1:1331 PRAIRIE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4867
Mailing Address - Country:US
Mailing Address - Phone:307-778-3121
Mailing Address - Fax:
Practice Address - Street 1:1331 PRAIRIE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4867
Practice Address - Country:US
Practice Address - Phone:307-778-3121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW307673OtherMEDICARE GROUP#
WY104197500Medicaid
WYW307673OtherMEDICARE GROUP#