Healthcare Provider Details

I. General information

NPI: 1306196209
Provider Name (Legal Business Name): CEDARS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S DURBIN ST
CASPER WY
82601-2818
US

IV. Provider business mailing address

428 S DURBIN ST SUITE 201
CASPER WY
82601-2818
US

V. Phone/Fax

Practice location:
  • Phone: 307-277-3867
  • Fax:
Mailing address:
  • Phone: 307-277-3867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHEL SKAF
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 307-277-3867