Provider Demographics
NPI:1962593368
Name:WYOMING ENDOCRINE & DIABETES CLINIC LLC
Entity type:Organization
Organization Name:WYOMING ENDOCRINE & DIABETES CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXTERNAL FINANCIAL CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STUTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-577-2767
Mailing Address - Street 1:PO BOX 51106
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605
Mailing Address - Country:US
Mailing Address - Phone:307-237-8400
Mailing Address - Fax:307-233-0290
Practice Address - Street 1:940 E 3RD ST
Practice Address - Street 2:SUITE 211
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3237
Practice Address - Country:US
Practice Address - Phone:307-237-8400
Practice Address - Fax:307-233-0290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYOMING MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY06060001OtherBLUE CROSS BLUE SHIELD
WYDF9300OtherRAILROAD MEDICARE
WYDF9300OtherRAILROAD MEDICARE