Healthcare Provider Details

I. General information

NPI: 1114017167
Provider Name (Legal Business Name): WOMENS HEALTH ASSOCIATES OF WY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E 2ND ST
CASPER WY
82601-2903
US

IV. Provider business mailing address

1125 E 2ND ST
CASPER WY
82601-2903
US

V. Phone/Fax

Practice location:
  • Phone: 307-577-4225
  • Fax: 307-577-4229
Mailing address:
  • Phone: 307-577-4225
  • Fax: 307-577-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6581A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6681A
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2811A
License Number StateWY

VIII. Authorized Official

Name: DR. SAM T SCALING
Title or Position: PRESIDENT
Credential: MD
Phone: 307-577-4225