Fremont Anesthesia Associate, PLLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

FREMONT ANESTHESIA ASSOCIATE, PLLC

Practice address

2100 W Sunset Dr
Riverton, WY 82501-2274

Phone

(800) 967-1646

Fax

(317) 567-2191

NPI assigned

Sep 28, 2007

Organization subpart

No

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

Authorized official

Name

Matthew A Mullinix, CRNA

Title

Managing Group Member

Phone

(307) 856-4161

Specialties & licenses 2

Addresses

Other identifiers 3

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259107200000",
    "number": "1053508564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30918",
            "city": "BILLINGS",
            "state": "MT",
            "postal_code": "591160918",
            "telephone_number": "317-567-2180",
            "fax_number": "317-567-2191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 W SUNSET DR",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825012274",
            "telephone_number": "800-967-1646",
            "fax_number": "317-567-2191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT ANESTHESIA ASSOCIATE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-28",
        "last_updated": "2009-11-25",
        "status": "A",
        "authorized_official_last_name": "MULLINIX",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING GROUP MEMBER",
        "authorized_official_telephone_number": "307-856-4161",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "WY",
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG4268",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053508564",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "06208001",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Certified Registered Nurse Anesthetist in Riverton, WY
• Providers in Riverton, WY by specialty
• Certified Registered Nurse Anesthetist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2009; 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.