Provider Demographics
NPI:1588729776
Name:MARY C NEAL, MD PC
Entity type:Organization
Organization Name:MARY C NEAL, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-734-5999
Mailing Address - Street 1:PO BOX 7369
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-7369
Mailing Address - Country:US
Mailing Address - Phone:307-734-5999
Mailing Address - Fax:307-734-0345
Practice Address - Street 1:945 W BROADWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-734-5999
Practice Address - Fax:307-734-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6101A332B00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY05681001OtherBLUE CROSS BLUE SHIELD
W20066Medicare PIN
WY05681001OtherBLUE CROSS BLUE SHIELD
WYW20060Medicare PIN
5440900001Medicare NSC
DD1095Medicare PIN