Basic Information
| Provider Information | |||||||||
| NPI: | 1730550765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | S. SPINDLE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2230 | ||||||||
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| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820032230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076380300 | ||||||||
| FaxNumber: | 3076380394 | ||||||||
| Practice Location | |||||||||
| Address1: | 4620 GRANDVIEW AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820094964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076384733 | ||||||||
| FaxNumber: | 3078379108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2015 | ||||||||
| LastUpdateDate: | 03/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | TETENTA | ||||||||
| AuthorizedOfficialFirstName: | SODIENYE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3076384733 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.