Provider Demographics
NPI:1518011626
Name:CHEYENNE OBSTETRICS AND GYNECOLOGY INC PC
Entity type:Organization
Organization Name:CHEYENNE OBSTETRICS AND GYNECOLOGY INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHELENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-634-5216
Mailing Address - Street 1:2301 HOUSE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3176
Mailing Address - Country:US
Mailing Address - Phone:307-634-5216
Mailing Address - Fax:307-638-6675
Practice Address - Street 1:2301 HOUSE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3176
Practice Address - Country:US
Practice Address - Phone:307-634-5216
Practice Address - Fax:307-638-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty