Healthcare Provider Details

I. General information

NPI: 1386155406
Provider Name (Legal Business Name): CEDARS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 HIGHLAND AVE
SHERIDAN WY
82801-2729
US

IV. Provider business mailing address

428 S DURBIN ST STE 104
CASPER WY
82601-2818
US

V. Phone/Fax

Practice location:
  • Phone: 307-673-5501
  • Fax:
Mailing address:
  • Phone: 307-337-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHEL W SKAF
Title or Position: CEO
Credential:
Phone: 307-337-4284