PREMISE HEALTH OF WYOMING MEDICAL PC NPI 1447661319

NPI Information

NPI: 1447661319
Provider Name: PREMISE HEALTH OF WYOMING MEDICAL PC

Former Legal Business Name: HEALTHWORKS MED GROUP OF WYOMING PC

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 53D2000021

Address:
2723 CHRISTENSEN RD
CHEYENNE, WY
ZIP 82007
Phone: (307) 637-0736
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PREMISE HEALTH OF WYOMING MEDICAL PC is a multi-specialty clinic center in Cheyenne, WY. PREMISE HEALTH OF WYOMING MEDICAL PC NPI is 1447661319. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Healthworks Med Group Of Wyoming Pc.

The provider's business location address is:

2723 CHRISTENSEN RD
CHEYENNE, WY
ZIP 82007-662
Phone: (307) 637-0736
Fax: (307) 637-0715

The provider's authorized official is Jonathan Leizman .
The authorized official title is President and has the following contact phone number (216) 479-9063.

The CLIA number assigned to this NPI record is 53D2000021 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/14/2014 and was last updated on 10/9/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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