=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871803874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CY EDWARDS MD OF WY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2010
-----------------------------------------------------
Last Update Date | 11/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 940 E 3RD ST. SUITE 211
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601-3251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-235-0000
-----------------------------------------------------
Fax | 307-235-0019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 940 E 3RD ST. SUITE 211
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601-3251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-235-0000
-----------------------------------------------------
Fax | 307-235-0019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHERYL Y EDWARDS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 307-235-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 4301081097
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 7878A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 12986
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------