Active NPI
Michael J Murdock, M.S. CCC
- Speech-Language Pathologist
- Lander, WY
National Provider Identifier
1104024033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 074
- Practice address
- 1425 Buena Vista Dr
Lander, WY 82520-3463 - Phone
- (307) 349-2998
- NPI assigned
- Jul 3, 2007
- Last updated
- Feb 17, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 074 | WY | Primary |
Addresses
Primary practice location
1425 Buena Vista Dr
Lander, WY 82520-3463
Mailing address
1425 Buena Vista Dr
PO Box 202
Lander, WY 82520-3463
Phone (307) 349-2998
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 074 | Other | WY | WYOMING SPEECH AND HEARING ASSOCIATION |
| 01028456 | Other | ASHA CERTIFICATION | |
| 074 | Other | WY | STATE LICENSURE |
| 2226 | Other | CO | COLORADO SPEECH AND HEARING ASSOCIATION |
| 163770 | Other | CA | CALIFORNIA SPEECH HEARING |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 074 | WY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holistic Pain Management of Wyoming, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Nurse Practitioner
- Riverton, WY
- NPI 1487295846
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424131200000",
"number": "1104024033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1425 BUENA VISTA DR",
"address_2": "PO BOX 202",
"city": "LANDER",
"state": "WY",
"postal_code": "825203463",
"telephone_number": "307-349-2998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 BUENA VISTA DR",
"city": "LANDER",
"state": "WY",
"postal_code": "825203463",
"telephone_number": "307-349-2998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MURDOCK",
"first_name": "MICHAEL",
"middle_name": "J",
"credential": "M.S. CCC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-03",
"last_updated": "2015-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WY",
"license": "074",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WYOMING SPEECH AND HEARING ASSOCIATION",
"identifier": "074",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA CERTIFICATION",
"identifier": "01028456",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSURE",
"identifier": "074",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLORADO SPEECH AND HEARING ASSOCIATION",
"identifier": "2226",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA SPEECH HEARING",
"identifier": "163770",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lander, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.