Healthcare Provider Details

I. General information

NPI: 1447293113
Provider Name (Legal Business Name): WESTERN AMBULATORY SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 WILKINS CIR
CASPER WY
82601-1337
US

IV. Provider business mailing address

1421 WILKINS CIR
CASPER WY
82601-1337
US

V. Phone/Fax

Practice location:
  • Phone: 307-237-2511
  • Fax: 307-237-7351
Mailing address:
  • Phone: 307-237-2511
  • Fax: 307-237-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number06-188
License Number StateWY

VIII. Authorized Official

Name: DR. MATTHEW TAYLOR DODDS
Title or Position: OWNER
Credential: M.D
Phone: 307-237-2511