Healthcare Provider Details

I. General information

NPI: 1730550765
Provider Name (Legal Business Name): S. SPINDLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 GRANDVIEW AVE STE 201
CHEYENNE WY
82009-4964
US

IV. Provider business mailing address

PO BOX 2417
CHEYENNE WY
82003-2417
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-4733
  • Fax: 307-837-9108
Mailing address:
  • Phone: 307-638-0300
  • Fax: 307-638-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SODIENYE TETENTA
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 307-638-4733