KODIAK ANESTHESIA PC (NPI# 1710087689) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710087689 |
| Entity Type | Organization |
| Organization Name | KODIAK ANESTHESIA PC |
| Practice Address |
111 W 2nd St Suite 415 Casper WY 82601-2454 |
| Practice Telephone | 3072375848 |
| Practice Fax Number | 3072375848 |
| Mailing Telephone | 3072375848 |
| Mailing Fax Number | 3072375848 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2014-10-08 |
| Authorized Official Name | MATTHEW D. CHYNOWETH (MD) |
| Authorized Official Telephone | 3072375848 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 170100000X | Medical Genetics, Ph.D. Medical Genetics | 7192A | WY | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295138972 | Kodiak Anesthesia PC | Anesthesiology | 4850 Chinook Trl, Casper, WY 82604-5201 | 2014-10-08 |
| Street Address |
111 W 2ND ST SUITE 415 |
| City | CASPER |
| State | WY |
| Zip Code | 82601-2454 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922351063 | Arlene Viray | Counselor | 111 W 2nd St, Suite 305, Casper, WY 82601-2454 | 2012-10-25 |
| 1982802252 | Lesley Suzanne Travers | Counselor | 111 W 2nd St, Suite 613, Casper, WY 82601-2454 | 2007-07-06 |
| 1114149655 | Deborah Ann Miller | Nurse Practitioner | 111 W 2nd St, Suite 305, Casper, WY 82601-2464 | 2007-05-03 |
| 1093803918 | David Barahal | Medical Genetics, Ph.D. Medical Genetics | 111 W 2nd St, Suite 415, Casper, WY 82601-2454 | 2006-10-10 |
| 1750479663 | Kerry Morrison | Medical Genetics, Ph.D. Medical Genetics | 111 W 2nd St, Suite 415, Casper, WY 82601-2454 | 2006-10-10 |
| 1942395686 | Kerry G Engelking | Medical Genetics, Ph.D. Medical Genetics | 111 W 2nd St, Suite 415, Casper, WY 82601-2454 | 2006-10-04 |
| 1376658104 | Matthew D Chynoweth | Medical Genetics, Ph.D. Medical Genetics | 111 W 2nd St, #415, Casper, WY 82601-2454 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407472715 | Kira Christine Schaab | Student in an Organized Health Care Education/Training Program | University of Wyoming Fmrp - Casper 1522 East A Street, Casper, WY 82601 | 2020-06-23 |
| 1386111300 | Kyle David Gordon | Pharmacist | 2625 E. 2nd St., Pharmacy, Casper, WY 82601 | 2018-10-29 |
| 1225534050 | Stephanie Wendling | Social Worker | 143 S Summit St., Casper, WY 82601 | 2018-04-02 |
| 1457877987 | Deer Creek Dentistry, PC | Dentist | 514 South Durbin Street, Casper, WY 82601 | 2017-08-16 |
| 1679096382 | Rachael Kristin Clark | Case Management | 2317 Absaroka Trail, Bar Nunn, WY 82601 | 2017-07-25 |
| 1366998692 | Trenton Vonburg | Occupational Therapy Assistant | 2744 Fairdale Ave, Casper, WY 82601 | 2016-08-28 |
| 1619326618 | Traci L Aguilar | Massage Therapist | 221 S. Walcott, Casper, WY 82601 | 2016-06-09 |
| 1801256656 | Anita Walker | Speech-Language Pathologist | 851 Werner Ct., Ste. 100, Sensational Kids, Casper, WY 82601 | 2016-03-07 |
| 1528444304 | Jack Miller | Pharmacist | 1262 S. Conwell Stc, Casper, WY 82601 | 2015-08-04 |
| 1437556453 | Kelly Jo Plessman | Nurse Practitioner | 2521 East 15th Street, Casper, WY 82601 | 2014-11-20 |
| Find all providers in zip 82601 | ||||
| Taxonomy Code | 170100000X |
| Grouping | Other Service Providers |
| Classification | Medical Genetics, Ph.D. Medical Genetics |
| A medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program, and serves as a consultant to medical and dental specialists. |
| Notes: A general certificate was first issued by ABMS in 1982. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093803918 | David Barahal | Medical Genetics, Ph.D. Medical Genetics | 111 W 2nd St, Suite 415, Casper, WY 82601-2454 | 2006-10-10 |
| 1750479663 | Kerry Morrison | Medical Genetics, Ph.D. Medical Genetics | 111 W 2nd St, Suite 415, Casper, WY 82601-2454 | 2006-10-10 |
| 1942395686 | Kerry G Engelking | Medical Genetics, Ph.D. Medical Genetics | 111 W 2nd St, Suite 415, Casper, WY 82601-2454 | 2006-10-04 |
| 1376658104 | Matthew D Chynoweth | Medical Genetics, Ph.D. Medical Genetics | 111 W 2nd St, #415, Casper, WY 82601-2454 | 2006-08-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.