Provider Demographics
NPI:1568290161
Name:WYOMING OTOLARYNGOLOGY, P.C.
Entity type:Organization
Organization Name:WYOMING OTOLARYNGOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLONINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-577-4240
Mailing Address - Street 1:2210 KING BLVD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3165
Mailing Address - Country:US
Mailing Address - Phone:307-577-4240
Mailing Address - Fax:
Practice Address - Street 1:2210 KING BLVD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3165
Practice Address - Country:US
Practice Address - Phone:307-577-4240
Practice Address - Fax:307-577-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty