Healthcare Provider Details

I. General information

NPI: 1275583965
Provider Name (Legal Business Name): WESTERN MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 E 2ND ST SUITE 200
CASPER WY
82609-4321
US

IV. Provider business mailing address

6500 E 2ND ST SUITE 200
CASPER WY
82609-4321
US

V. Phone/Fax

Practice location:
  • Phone: 307-577-5100
  • Fax: 307-233-0610
Mailing address:
  • Phone: 307-577-5100
  • Fax: 307-233-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY CE ANDERSON
Title or Position: BUSINESS OFFICE MANAGER
Credential: CPC
Phone: 307-577-5100