Snake River Plastic Surgery LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

2735A Issued in WY

Legal business name

SNAKE RIVER PLASTIC SURGERY LLC

Practice address

555 E. Broadway
Suite 212
Jackson, WY 83001

Phone

(307) 733-6077

NPI assigned

Jun 25, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Michael Barry Gellis, MDNPI 1508997032

Title

Member

Phone

(307) 733-6077

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Michael Barry Gellis, M.D.

  • Plastic Surgery Physician
  • Jackson, MI
  • NPI 1508997032
  NPD (past) Authorized official

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277424000000",
    "number": "1104137074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2862",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830012862",
            "telephone_number": "307-733-6077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E. BROADWAY",
            "address_2": "SUITE 212",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83001",
            "telephone_number": "307-733-6077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNAKE RIVER PLASTIC SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-25",
        "last_updated": "2010-06-25",
        "status": "A",
        "authorized_official_last_name": "GELLIS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "BARRY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "307-733-6077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WY",
            "license": "2735A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1508997032",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin McCollough Smith, ED.D
• William R Smith, MD
• Smiths Food & Drug Centers Inc
• Christopher Smithwick
• Snake River Consulting LLC
• Kathryn Sobieski, M. D.
• Heidi Christine Somers, M.A., L.M.F.T
• Krysten Gayle Sommerville, OTR
• Starr Marie Sonne, M.ED.; LPC
• Sports and Rehabilitation Center of Wyoming LLC

• Specialist in Jackson, WY
• Providers in Jackson, WY by specialty
• Specialist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2010; 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.