Healthcare Provider Details

I. General information

NPI: 1265908321
Provider Name (Legal Business Name): WYOMING ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 E 2ND ST
CASPER WY
82601-2926
US

IV. Provider business mailing address

PO BOX 50672
CASPER WY
82605-0672
US

V. Phone/Fax

Practice location:
  • Phone: 800-822-7201
  • Fax:
Mailing address:
  • Phone: 800-222-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW CHYNOWETH
Title or Position: MANAGING EMPLOYEE
Credential: MD
Phone: 307-277-4305