NPIMap

Organization Active NPI

Cheyenne Medical Plaza Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Cheyenne, WY
National Provider Identifier
1902803158
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
06-186 Issued in WY
Legal business name
CHEYENNE MEDICAL PLAZA SURGERY CENTER, LLC
Practice address
2301 House Ave
#200
Cheyenne, WY 82001-3176
Phone
(307) 635-7070
Fax
(307) 433-9311
NPI assigned
Jul 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Take George Pullos, M.D.
Title
Medical Director
Phone
(307) 635-7070

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 06-186 WY Primary

Addresses

Primary practice location

2301 House Ave
#200
Cheyenne, WY 82001-3176

Mailing address

2301 House Ave
#200
Cheyenne, WY 82001-3176
Phone (307) 635-7070

Other names 1

  • Yellowstone Surgery Center Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1120262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902803158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 HOUSE AVE",
            "address_2": "#200",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013176",
            "telephone_number": "307-635-7070",
            "fax_number": "307-433-9311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 HOUSE AVE",
            "address_2": "#200",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013176",
            "telephone_number": "307-635-7070",
            "fax_number": "307-433-9311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEYENNE MEDICAL PLAZA SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PULLOS",
        "authorized_official_first_name": "TAKE",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "307-635-7070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WY",
            "license": "06-186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yellowstone Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 22, 2020; 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.