Basic Information
| Provider Information | |||||||||
| NPI: | 1568815843 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRONTIER ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7220 COMMONS CIR | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820092673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076354141 | ||||||||
| FaxNumber: | 3076356587 | ||||||||
| Practice Location | |||||||||
| Address1: | 7220 COMMONS CIR | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820092673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076354141 | ||||||||
| FaxNumber: | 3076356587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2016 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCRAE | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3076354141 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.