Healthcare Provider Details

I. General information

NPI: 1003952821
Provider Name (Legal Business Name): WYOMING CANCER SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 2ND ST SUITE D
ROCK SPRINGS WY
82901-6260
US

IV. Provider business mailing address

3576 GARDEN CREEK HTS
CASPER WY
82601-6644
US

V. Phone/Fax

Practice location:
  • Phone: 307-382-5116
  • Fax: 307-382-5118
Mailing address:
  • Phone: 307-262-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number6639A
License Number StateWY

VIII. Authorized Official

Name: DR. KEITH R MILLS
Title or Position: OWNER
Credential: MD
Phone: 307-382-5116