Healthcare Provider Details

I. General information

NPI: 1700524766
Provider Name (Legal Business Name): CITY OF CHEYENNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 W 19TH ST
CHEYENNE WY
82001-4309
US

IV. Provider business mailing address

415 W 18TH ST
CHEYENNE WY
82001-4331
US

V. Phone/Fax

Practice location:
  • Phone: 307-630-6320
  • Fax:
Mailing address:
  • Phone: 307-637-6311
  • Fax: 307-637-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN KOPPER
Title or Position: DEPARTMENT CHIEF
Credential: CHIEF
Phone: 307-637-6315