Wyoming Heart and Vascular Center LLC

Key facts

NPI: 1932889482
Entity type: Organization (NPI type 2)
Primary specialty: Cardiovascular Disease Physician 207RC0000X
Legal business name: WYOMING HEART AND VASCULAR CENTER LLC
Practice address: 1204 Hilltop Dr Ste 106
Rock Springs, WY 82901-5861
Phone: (307) 522-5555
Fax: (888) 819-5155
NPI assigned: Jul 20, 2023
Organization subpart: No

Authorized official

Name: Dr. Mansour Khaddr, MD
Title: Cardiologist/Managing Member
Phone: (412) 626-0143

Practitioners 1

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

Mansour Eltaher Khaddr, M.D. Cardiovascular Disease Physician · Rock Springs, WY · NPI 1124384797

Medicare reassignment NPD CARDIOVASCULAR DISEASE · WY

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
53D2295746	Wyoming Heart and Vascular Center 1204 Hilltop Dr, Suite 106, Rock Springs, WY 82901	Certificate of waiver	Dec 14, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in WY

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20231004001913	WY	Part B Supplier - Clinic/Group Practice	0244685634	Receives reassigned benefits from 1 practitioner Practice locations: Rock Springs, WY

National Provider Directory

Locations

1204 Hilltop Dr
Ste 6
Rock Springs, WY 82901

1204 Hilltop Dr
Ste 104
Rock Springs, WY 82901

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Cardiovascular Disease Physician Group: 193400000X SINGLE SPECIALTY GROUP	207RC0000X			Yes

Addresses

Primary practice location

1204 Hilltop Dr Ste 106
Rock Springs, WY 82901-5861

Mailing address

1204 Hilltop Dr Ste 106
Rock Springs, WY 82901-5861
Phone (307) 522-5555

Other providers in Rock Springs, WY

All providers in Rock Springs, WY · Cardiovascular Disease Physician in Wyoming

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.