Active NPI
Wyoming Surgical Center LLC
- Ambulatory Surgical Clinic/Center
- Casper, WY
National Provider Identifier
1942261573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- License
- 08 012
- Legal business name
- WYOMING SURGICAL CENTER LLC
- Practice address
- 4140 Centennial Hills Blvd
#C
Casper, WY 82609 - Phone
- (307) 472-8781
- Fax
- (307) 472-8887
- NPI assigned
- Mar 31, 2006
- Last updated
- May 13, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Charles Robertson
- Title
- Administrator
- Phone
- (307) 472-8781
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | 08 012 | WY | Primary |
Addresses
Primary practice location
4140 Centennial Hills Blvd
#C
Casper, WY 82609
Mailing address
4140 Centennial Hills Blvd
#C
Casper, WY 82609
Phone (307) 472-8781
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 490005195 | Other | WY | RAILROAD MEDICARE |
| 116664600 | Medicaid | WY | |
| 310945 | Other | WY | BLUE CROSS BLUE SHIELD OF WYOMING |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080911000329 | WY | Part B Supplier - Ambulatory Surgical Center | 9133295355 | Practice locations: Casper, WY |
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Wyoming Surgical Center LLC
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1210636800000",
"number": "1942261573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4140 CENTENNIAL HILLS BLVD",
"address_2": "#C",
"city": "CASPER",
"state": "WY",
"postal_code": "82609",
"telephone_number": "307-472-8781",
"fax_number": "307-472-8887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4140 CENTENNIAL HILLS BLVD",
"address_2": "#C",
"city": "CASPER",
"state": "WY",
"postal_code": "82609",
"telephone_number": "307-472-8781",
"fax_number": "307-472-8887"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WYOMING SURGICAL CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-31",
"last_updated": "2008-05-13",
"status": "A",
"authorized_official_last_name": "ROBERTSON",
"authorized_official_first_name": "CHARLES",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "307-472-8781"
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": "WY",
"license": "08 012",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "490005195",
"state": "WY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "116664600",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF WYOMING",
"identifier": "310945",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Casper, WY
- Wyoming Psychiatry, LLC
- Wyoming Reconstructive & Plastic Surgery LLC
- Wyoming Retina Associates, PC
- Wyoming Sleep Diagnostics, Inc.
- Wyoming Surgical Associates PC
- Wyoming Surgical Center MRI
- Wyoming Trauma Treatment Center
- Wyoming Wound Care Center PC
- Demian Matthew Yakel, D.O.
- Shelby Yates, MSN, FNP-BC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; 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.