NPIMap

Organization Active NPI

Sweetwater Radiology, PC

  • Diagnostic Radiology Physician
  • Green River, WY
National Provider Identifier
1952344137
Registry record updated Aug 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SWEETWATER RADIOLOGY, PC
Practice address
1400 Uinta Dr
Green River, WY 82935-5060
Phone
(307) 872-4541
NPI assigned
Jun 14, 2006
Last updated
Aug 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2011

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

Authorized official

Name
Dr. Brian A Holtan, MD
Title
President
Phone
(623) 399-3266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

1400 Uinta Dr
Green River, WY 82935-5060

Mailing address

PO Box 2146
Rock Springs, WY 82902-2146
Phone (405) 947-5557

Other identifiers 2

IdentifierTypeStateIssuer
00983001OtherWYBCBS OF WY
106271900MedicaidWY

National Provider Directory

National Provider Directory

Locations

2620 Commercial Way
Ste 10
Rock Springs, WY 82901
Phone (307) 371-0577

Practitioners & affiliated clinicians

Practitioners 6

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": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312502400000",
    "number": "1952344137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2146",
            "city": "ROCK SPRINGS",
            "state": "WY",
            "postal_code": "829022146",
            "telephone_number": "405-947-5557",
            "fax_number": "405-948-6507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 UINTA DR",
            "city": "GREEN RIVER",
            "state": "WY",
            "postal_code": "829355060",
            "telephone_number": "307-872-4541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWEETWATER RADIOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2011-08-05",
        "status": "A",
        "authorized_official_last_name": "HOLTAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "623-399-3266",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF  WY",
            "identifier": "00983001",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106271900",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green River, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; 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.