Healthcare Provider Details

I. General information

NPI: 1306826177
Provider Name (Legal Business Name): NORTHERN WYOMING SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 LINDSAY LN
CODY WY
82414-4103
US

IV. Provider business mailing address

732 LINDSAY LN
CODY WY
82414-4103
US

V. Phone/Fax

Practice location:
  • Phone: 307-587-2139
  • Fax: 307-587-2365
Mailing address:
  • Phone: 307-587-2139
  • Fax: 307-587-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number06014
License Number StateWY

VIII. Authorized Official

Name: CINDY ROHDE
Title or Position: ADMINISTRATOR
Credential:
Phone: 307-587-2139