NPIMap

Organization Active NPI

Cheyenne Children's Clinic, PC

  • Pediatrics Physician
  • Cheyenne, WY
National Provider Identifier
1073537601
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHEYENNE CHILDREN'S CLINIC, PC
Practice address
2301 House Ave
Suite 405
Cheyenne, WY 82001-3176
Phone
(307) 635-7961
Fax
(307) 778-5812
NPI assigned
Jul 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robin Theobald
Title
Clinic Administrator
Phone
(307) 635-7961

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

2301 House Ave
Suite 405
Cheyenne, WY 82001-3176

Mailing address

2301 House Ave
Suite 405
Cheyenne, WY 82001-3176
Phone (307) 635-7961

National Provider Directory

National Provider Directory

Locations

4017 Rawlins St
Cheyenne, WY 82001
Phone (307) 635-2562

4116 Laramie St
Cheyenne, WY 82001
Phone (307) 634-9311

Practitioners & affiliated clinicians

Practitioners 94

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.

View all 94

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073537601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 HOUSE AVE",
            "address_2": "SUITE 405",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013176",
            "telephone_number": "307-635-7961",
            "fax_number": "307-778-5812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 HOUSE AVE",
            "address_2": "SUITE 405",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013176",
            "telephone_number": "307-635-7961",
            "fax_number": "307-778-5812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEYENNE CHILDREN'S CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THEOBALD",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "307-635-7961"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.