Provider Demographics
NPI:1982808481
Name:CHEYENNE WOMENS CLINIC,PC
Entity Type:Organization
Organization Name:CHEYENNE WOMENS CLINIC,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-637-7700
Mailing Address - Street 1:3952 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-8102
Mailing Address - Country:US
Mailing Address - Phone:307-637-7700
Mailing Address - Fax:307-637-5672
Practice Address - Street 1:3952 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-8102
Practice Address - Country:US
Practice Address - Phone:307-637-7700
Practice Address - Fax:307-637-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6197A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty