Provider Demographics
NPI:1194721050
Name:HIGH PLAINS SURGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:HIGH PLAINS SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARTSAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-682-7555
Mailing Address - Street 1:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-1272
Mailing Address - Country:US
Mailing Address - Phone:307-682-7555
Mailing Address - Fax:307-687-7243
Practice Address - Street 1:3100 W LAKEWAY RD STE 1
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6373
Practice Address - Country:US
Practice Address - Phone:307-682-7555
Practice Address - Fax:307-687-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYHAR308412OtherBLUE CROSS
WY020028051Medicare PIN
WYW308411Medicare PIN