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General NPI Number Information
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NPI Number | 1003952821
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Entity Type | Organization
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Legal Business Name | WYOMING CANCER SPECIALISTS LLC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 400 2ND ST SUITE D
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-6260
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Country | US
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Telephone | 307-382-5116
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Fax | 307-382-5118
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Provider Business Mailing Address
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Address Line | 3576 GARDEN CREEK HTS
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City | CASPER
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State | WY
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Zip | 82601-6644
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Country | US
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Telephone | 307-262-5949
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH R MILLS
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Credential | MD
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Telephone | 307-382-5116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 6639A
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License Number State | WY
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