Healthcare Provider Details

I. General information

NPI: 1093474983
Provider Name (Legal Business Name): CHEYENNE REGIONAL PHYSICIANS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 RAWLINS ST
CHEYENNE WY
82001-1800
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-8987
  • Fax: 307-638-7829
Mailing address:
  • Phone: 307-996-4777
  • Fax: 307-773-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGARET E. ALLEN
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 307-773-8237