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NPI Code Detail

MEDICARE: MR. BRECK S GROSKREUTZ PA-C

MEDICARE: MR. BRECK S GROSKREUTZ PA-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
1363A00000XPhysician AssistantPA893WY
2207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianPA893WY

General Provider Information

NPI Number : 1972130565
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRECK S GROSKREUTZ PA-C
Provider Business Mailing Address
First Line : 4140 CENTENNIAL HILLS BLVD STE A
Second Line :
City : CASPER
State : WY
Zip : 82609-3265
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4140 CENTENNIAL HILLS BLVD STE A
Second Line :
City : CASPER
State : WY
Zip : 82609-3265
Country : US
Telephone Number : 307-265-7205
Fax Number : 307-235-6262
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2020
Last Update Date : 06/09/2026

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