Basic Information
| Provider Information | |||||||||
| NPI: | 1093474983 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHEYENNE REGIONAL PHYSICIANS GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20970 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820037020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3079964777 | ||||||||
| FaxNumber: | 3077738013 | ||||||||
| Practice Location | |||||||||
| Address1: | 4017 RAWLINS ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820011800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076388987 | ||||||||
| FaxNumber: | 3076387829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2021 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BILLING | ||||||||
| AuthorizedOfficialTelephone: | 3077738237 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHEYENNE REGIONAL PHYSICIANS GROUP, LLC | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0105X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand |
No ID Information.