Healthcare Provider Details

I. General information

NPI: 1598751075
Provider Name (Legal Business Name): WYOMING SURGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S WASHINGTON ST SUITE 200
CASPER WY
82601-2951
US

IV. Provider business mailing address

419 S WASHINGTON ST STE 200
CASPER WY
82601-2951
US

V. Phone/Fax

Practice location:
  • Phone: 307-577-4220
  • Fax: 307-235-0931
Mailing address:
  • Phone: 307-577-4220
  • Fax: 307-235-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIANA DEJOURNETT
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 307-232-5402