MEDICARE: WYOMING CANCER SPECIALISTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	6639A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	05922001	OTHER	WY	BCBS

General Provider Information

NPI Number	:	1003952821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYOMING CANCER SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	3576 GARDEN CREEK HTS
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-6644
Country	:	US
Telephone Number	:	307-262-5949
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 2ND ST
Second Line	:	SUITE D
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-6260
Country	:	US
Telephone Number	:	307-382-5116
Fax Number	:	307-382-5118

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEITH R MILLS
Credential	:	MD
Telephone Number	:	307-382-5116

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	11/06/2008

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