Wyco Derm LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

WYCO DERM LLC

Doing business as

Seitz Dermatology

Practice address

8305 Wellington Blvd Unit 102
Wellington, CO 80549-2399

Phone

(307) 635-8299

Fax

(307) 635-6984

NPI assigned

Nov 20, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Gregory W Seitz, MDNPI 1962676353

Title

Owner

Phone

(307) 635-8299

Specialties & licenses 4

Addresses

Other names 1

• Seitz Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Seitz Dermatology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wyco Derm LLC

  • Clinical & Laboratory Dermatological Immunology Physician
  • Timnath, CO
  • NPI 1306700588
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gregory Seitz

  • Dermatology Physician
  • Cheyenne, WY
  • NPI 1962676353

  CO

  Medicare reassignment Care Compare group NPD Authorized official
• Frances Colleen Basham, MSN, APRN, FNP-C

  • Family Nurse Practitioner
  • Wellington, CO
  • NPI 1467238790
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1700438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1043085020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 SEYMOUR AVE",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013830",
            "telephone_number": "307-635-8299",
            "fax_number": "307-635-6984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8305 WELLINGTON BLVD UNIT 102",
            "city": "WELLINGTON",
            "state": "CO",
            "postal_code": "805492399",
            "telephone_number": "307-635-8299",
            "fax_number": "307-635-6984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYCO DERM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-20",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A",
        "authorized_official_last_name": "SEITZ",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-635-8299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seitz Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Reginald R. Westphal, D.D.S., M.S.
• Kathryn Ann Wilson, LCSW
• Breanne Winterling
• Vicki Lynn Witmer, N.P.
• Elaine Woo
• Dawn Wynne, CMT, ESTI
• Amanda Zimmerman, CNM, FNP-C
• Fadi Zrik, DDS
• Jina Zrik, DDS

• Medical Specialty Clinic/Center in Wellington, CO
• Providers in Wellington, CO by specialty
• Medical Specialty Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.