Premier Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PREMIER SURGICAL CENTER, LLC

Practice address

195 Overthrust Road
Evanston, WY 82930

Phone

(307) 444-3600

Fax

(307) 444-3610

NPI assigned

Jan 24, 2012

Last updated

Mar 26, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Stephen C Sheppard

Title

Administrator

Phone

(417) 889-2040

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Listed as

Premier Surgical Center LLCCCN 53C0001022

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

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

{
    "created_epoch": "1327363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332720000000",
    "number": "1417228370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 OVERTHRUST ROAD",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "82930",
            "telephone_number": "307-444-3600",
            "fax_number": "307-444-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 OVERTHRUST ROAD",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "82930",
            "telephone_number": "307-444-3600",
            "fax_number": "307-444-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-24",
        "last_updated": "2012-03-26",
        "status": "A",
        "authorized_official_last_name": "SHEPPARD",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "417-889-2040",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Platt, LPC
• Garrett E. Platt, LPN
• David Arland Pomerinke, PCSW
• James Allen Poppe
• Ferris Powell
• Tara Jean Prete
• Vanessa Renee Probert, LCSW
• Margaret B Prochaska, REGISTERED DIETITIAN
• Terry Roxanne Quillinan, RN NURSE
• Donald Roger Rardin, PH. D.

• Ambulatory Surgical Clinic/Center in Evanston, WY
• Providers in Evanston, WY by specialty
• Ambulatory Surgical Clinic/Center in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; 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.