| Brain Injury Association Of Wyoming | |
|
350 Big Horn Rd Ste 101 Casper WY 82601-1782 | |
| (307) 473-1767 | |
| Not Available |
| Full Name | Brain Injury Association Of Wyoming |
|---|---|
| Speciality | Clinic/Center |
| Location | 350 Big Horn Rd Ste 101, Casper, Wyoming |
| Authorized Official Name and Position | Daniel Cubbedge (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3074731767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brain Injury Association Of Wyoming Po Box 2984 Casper WY 82602-2984 Ph: (307) 473-1767 | Brain Injury Association Of Wyoming 350 Big Horn Rd Ste 101 Casper WY 82601-1782 Ph: (307) 473-1767 |
| NPI Number | 1003220096 |
|---|---|
| Provider Enumeration Date | 06/17/2014 |
| Last Update Date | 05/13/2025 |
| Certification Date | 05/13/2025 |
| Medicare PECOS PAC ID | 9638693658 |
|---|---|
| Medicare Enrollment ID | O20250410002722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003220096 | NPI | - | NPPES |
| 214737800 | Medicaid | WY | |
| 221397400 | Medicaid | WY | |
| 139437101 | Medicaid | WY | |
| 139437100 | Medicaid | WY |
| Provider Name | Rachel Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326703489 PECOS PAC ID: 1456705433 Enrollment ID: I20230925002009 |
| Provider Name | Cecilia Marie Stark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669040838 PECOS PAC ID: 2365960507 Enrollment ID: I20250520004594 |
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