Provider Demographics
NPI:1427291442
Name:WYOMING INTERVENTIONAL PAIN MANAGEMENT, P.C.
Entity type:Organization
Organization Name:WYOMING INTERVENTIONAL PAIN MANAGEMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JR
Authorized Official - Last Name:FRANDRUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-687-7246
Mailing Address - Street 1:PO BOX 2098
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-2098
Mailing Address - Country:US
Mailing Address - Phone:307-687-7246
Mailing Address - Fax:307-685-8027
Practice Address - Street 1:2001 W LAKEWAY RD STE D
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5774
Practice Address - Country:US
Practice Address - Phone:307-687-7246
Practice Address - Fax:307-685-8027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty