Basic Information
| Provider Information | |||||||||
| NPI: | 1790885523 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL WYOMING PATHOLOGISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50460 | ||||||||
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| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826050460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075775256 | ||||||||
| FaxNumber: | 3076877243 | ||||||||
| Practice Location | |||||||||
| Address1: | 1233 E 2ND ST | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826012926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075772198 | ||||||||
| FaxNumber: | 3076877243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 10/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | STINSON | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3075772198 | ||||||||
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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 | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.