NPIMap

Organization Active NPI

Cheyenne Skin Clinic LLP

  • Specialist
  • Cheyenne, WY
National Provider Identifier
1740427509
Registry record updated Jan 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CHEYENNE SKIN CLINIC LLP
Practice address
123 Western Hills Blvd
Cheyenne, WY 82009-3446
Phone
(307) 635-0226
NPI assigned
Jan 15, 2009
Last updated
Jan 15, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2009

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

Authorized official

Name
Sandra K Surbrugg, MDNPI 1699742957
Title
Managing Partner
Phone
(307) 635-0226

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

123 Western Hills Blvd
Cheyenne, WY 82009-3446

Mailing address

123 Western Hills Blvd
Cheyenne, WY 82009-3446
Phone (307) 635-0226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090501000296 WY Part B Supplier - Clinic/Group Practice 4183772122 Receives reassigned benefits from 11 practitioners
Practice locations: Cheyenne, WY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1231977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231977600000",
    "number": "1740427509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 WESTERN HILLS BLVD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820093446",
            "telephone_number": "307-635-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 WESTERN HILLS BLVD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820093446",
            "telephone_number": "307-635-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEYENNE SKIN CLINIC LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-15",
        "last_updated": "2009-01-15",
        "status": "A",
        "authorized_official_last_name": "SURBRUGG",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "307-635-0226",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "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 Jan 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.