Evanston Surgical Center LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

5079A Issued in WY

Legal business name

EVANSTON SURGICAL CENTER LLC

Practice address

196 Arrowhead Dr
Suite 8
Evanston, WY 82930-8752

Phone

(307) 789-1390

Fax

(307) 789-1391

NPI assigned

Apr 25, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael J O'Connor

Title

Owner/MD

Phone

(307) 789-1390

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amanda M Barnes, PA

  • Physician Assistant
  • Evanston, WY
  • NPI 1841435385
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224460800000",
    "number": "1003081522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 ARROWHEAD DR",
            "address_2": "SUITE 8",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829308752",
            "telephone_number": "435-613-9500",
            "fax_number": "435-613-9414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 ARROWHEAD DR",
            "address_2": "SUITE 8",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829308752",
            "telephone_number": "307-789-1390",
            "fax_number": "307-789-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANSTON SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-25",
        "last_updated": "2008-10-20",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "307-789-1390",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "WY",
            "license": "5079A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952367450",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evanston Hospital Corporation
• Evanston Hospital Corporation
• Evanston Hospital Corporation
• Evanston Internal Medicine Assoc.
• Evanston Regional Physicians LLC
• Evergreen Counseling
• Kenadee Eyre
• Beverly Fackrell, LPC
• Kristy H Faddis
• Melissa Faddis

• Surgery Physician in Evanston, WY
• Providers in Evanston, WY by specialty
• Surgery Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.