Basic Information
| Provider Information | |||||||||
| NPI: | 1609849199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARRELL | ||||||||
| FirstName: | ARTHUR | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5307 YELLOWSTONE RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820094736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076327677 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4136 LARAMIE ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820011969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076372800 | ||||||||
| FaxNumber: | 3076372867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 03/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 206 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 121860300 | 05 | WY | MEDICAID | 315527 | 01 | WY | BSWY | OTHER | 314333 | 01 | WY | BLUE CROSS BLUE SHIELD | OTHER |