Creekside Medical LLC

Primary specialty

Electrodiagnostic Medicine PhysicianTaxonomy code 204R00000X

Legal business name

CREEKSIDE MEDICAL LLC

Practice address

1910 Thomes Ave
Cheyenne, WY 82001-3527

Phone

(425) 890-6239

NPI assigned

Nov 6, 2017

Organization subpart

No

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

Authorized official

Name

Matthew Wavra

Title

Managing Member

Phone

(425) 890-6239

Specialties & licenses 1

Addresses

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JEBAAA

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

{
    "created_epoch": "1509926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537401600000",
    "number": "1487167052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4580 KLAHANIE DR SE # 252",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295812",
            "telephone_number": "833-613-9084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 THOMES AVE",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013527",
            "telephone_number": "425-890-6239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-06",
        "last_updated": "2018-09-20",
        "status": "A",
        "authorized_official_last_name": "WAVRA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "425-890-6239"
    },
    "taxonomies": [
        {
            "code": "204R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Electrodiagnostic Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Electrodiagnostic Medicine Physician in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Electrodiagnostic Medicine Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; 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.