MEDICARE: WESTERN WYOMING NEUROLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	7246A	WY

General Provider Information

NPI Number	:	1407942501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN WYOMING NEUROLOGY PC

Provider Business Mailing Address
First Line	:	PO BOX 970488
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84097-0488
Country	:	US
Telephone Number	:	801-473-7035
Fax Number	:	801-607-1467

Provider Business Practice Location Address
First Line	:	2751 COMMERCIAL WAY
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4753
Country	:	US
Telephone Number	:	307-382-6199
Fax Number	:	307-382-6449

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KAREN WATKINS
Credential	:
Telephone Number	:	801-473-7035

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	12/20/2007

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