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NPI Code Detail

MEDICARE: INTRAWEST MEDICAL SERVICES, P.C

MEDICARE: INTRAWEST MEDICAL SERVICES, P.C
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
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770503518
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTRAWEST MEDICAL SERVICES, P.C
Provider Business Mailing Address
First Line : 3908 E GRAND AVE
Second Line : SUITE 201
City : LARAMIE
State : WY
Zip : 82070-5173
Country : US
Telephone Number : 307-745-3168
Fax Number : 307-742-8449
Provider Business Practice Location Address
First Line : 255 N 30TH ST
Second Line : EMERGENCY DEPARTMENT
City : LARAMIE
State : WY
Zip : 82072-5140
Country : US
Telephone Number : 307-742-2142
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. DONALD L. CANTWAY
Credential : M.D.
Telephone Number : 307-745-3169
Provider Enumeration Date : 07/21/2006
Last Update Date : 10/05/2012

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Directions to “INTRAWEST MEDICAL SERVICES, P.C ” Practice Location

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