| Banner Hospital Based Physicians West Llc | |
|
1405 Howell Ave Worland WY 82401-4127 | |
| (307) 347-2555 | |
| (307) 347-9831 |
| Full Name | Banner Hospital Based Physicians West Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1405 Howell Ave, Worland, Wyoming |
| Authorized Official Name and Position | Dennis Laraway (SR VP FINANCE) |
| Authorized Official Contact | 6027474000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner Hospital Based Physicians West Llc 2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 Ph: () - | Banner Hospital Based Physicians West Llc 1405 Howell Ave Worland WY 82401-4127 Ph: (307) 347-2555 |
| NPI Number | 1619464120 |
|---|---|
| Provider Enumeration Date | 04/19/2018 |
| Last Update Date | 04/19/2018 |
| Medicare PECOS PAC ID | 5799131579 |
|---|---|
| Medicare Enrollment ID | O20231031001364 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619464120 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Sodienye Tetenta |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1447459763 PECOS PAC ID: 7517019102 Enrollment ID: I20090713000166 |
| Provider Name | William Oscar Sarette |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093875494 PECOS PAC ID: 4183860059 Enrollment ID: I20130419000110 |
| Provider Name | Brahmananda K Koduri |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659608214 PECOS PAC ID: 0547584427 Enrollment ID: I20150124000015 |
| Provider Name | Matthew R Crull |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285890475 PECOS PAC ID: 1254509672 Enrollment ID: I20151001002273 |
| Provider Name | Melissa M Knudson Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518124114 PECOS PAC ID: 3375707953 Enrollment ID: I20151006002990 |
| Provider Name | Kevin Fulford |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1063594612 PECOS PAC ID: 1355421173 Enrollment ID: I20200227002713 |
| Provider Name | Siavash Panah |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1114122876 PECOS PAC ID: 5890911366 Enrollment ID: I20210305001836 |
| Provider Name | Francis J Kaszuba |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1710940275 PECOS PAC ID: 2264431311 Enrollment ID: I20220127001011 |
| Provider Name | Gerald Blake Mclaughlin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1952476996 PECOS PAC ID: 3072694504 Enrollment ID: I20220427001096 |
| Provider Name | Stephen Anthony Nickisch |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578596615 PECOS PAC ID: 0042114514 Enrollment ID: I20220727001732 |
| Provider Name | Jessica Zeman |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1093869414 PECOS PAC ID: 6709050479 Enrollment ID: I20220810003308 |
| Provider Name | Nicole Piscatelli |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1437206562 PECOS PAC ID: 0042495145 Enrollment ID: I20220822000813 |
| Provider Name | James Colombo |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1972692069 PECOS PAC ID: 6002871464 Enrollment ID: I20220831001841 |
| Provider Name | Allison Harriott |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1023247871 PECOS PAC ID: 6709028616 Enrollment ID: I20220928003702 |
| Provider Name | Kyle Henry |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1194161588 PECOS PAC ID: 9931464591 Enrollment ID: I20230116000492 |
| Provider Name | Gina Lee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508014747 PECOS PAC ID: 0941445928 Enrollment ID: I20230123000576 |
| Provider Name | Amen Sergew |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1407993769 PECOS PAC ID: 6800813916 Enrollment ID: I20230127002015 |
| Provider Name | Tiffany Ynosencio |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1851735856 PECOS PAC ID: 9830445527 Enrollment ID: I20230222002545 |
| Provider Name | Nidhi Nikhanj |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1275589285 PECOS PAC ID: 9032115738 Enrollment ID: I20230223000824 |
| Provider Name | Shani Smith |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1659674240 PECOS PAC ID: 3577790906 Enrollment ID: I20230327001594 |
| Provider Name | Ravindra Gudavalli |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1649351222 PECOS PAC ID: 8628100765 Enrollment ID: I20230327002244 |
| Provider Name | Deven Kothari |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1962600270 PECOS PAC ID: 2961557202 Enrollment ID: I20230330003009 |
| Provider Name | Ronald Kembro |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1407890015 PECOS PAC ID: 1850538455 Enrollment ID: I20230427002567 |
| Provider Name | William D Mitchell |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134202575 PECOS PAC ID: 3678817228 Enrollment ID: I20230615001554 |
| Provider Name | Ryley Greenbaum |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1053708669 PECOS PAC ID: 1557662491 Enrollment ID: I20230629000887 |
| Provider Name | Anas Elkheder |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073562930 PECOS PAC ID: 3971533951 Enrollment ID: I20230629002656 |
| Provider Name | Dillon James Riebel |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760019616 PECOS PAC ID: 5698197143 Enrollment ID: I20230808001376 |
| Provider Name | Adam Scott Heessel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720648249 PECOS PAC ID: 8022433051 Enrollment ID: I20230815004426 |
| Provider Name | Ismaeel Mohamed Bakhsh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184243685 PECOS PAC ID: 4385007301 Enrollment ID: I20230823004268 |
| Provider Name | Dustin Ross Mayne |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780045427 PECOS PAC ID: 3375906191 Enrollment ID: I20230828001106 |
| Provider Name | Gene Tullis |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1366422073 PECOS PAC ID: 2163409244 Enrollment ID: I20230911002075 |
| Provider Name | Jane Lyons |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1407117039 PECOS PAC ID: 0042511164 Enrollment ID: I20231003002169 |
| Provider Name | Emily Lozano |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053392092 PECOS PAC ID: 3476677212 Enrollment ID: I20231003002383 |
| Provider Name | Shane Rainey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588041164 PECOS PAC ID: 4688989304 Enrollment ID: I20231106000326 |
| Provider Name | Umair Iqbal |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831579945 PECOS PAC ID: 7618229477 Enrollment ID: I20231220001478 |
| Provider Name | Jeffrey Kurrus |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1275561045 PECOS PAC ID: 1254231996 Enrollment ID: I20231227000185 |
| Provider Name | Dennis Daniels |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1265404222 PECOS PAC ID: 5991808628 Enrollment ID: I20240108000912 |
| Provider Name | Stephanie Woolley |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1952332876 PECOS PAC ID: 0446264238 Enrollment ID: I20240118001234 |
| Provider Name | Michael Figueroa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154438141 PECOS PAC ID: 8527057744 Enrollment ID: I20240124003148 |
| Provider Name | Donghong Zhang |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1477577435 PECOS PAC ID: 0143292052 Enrollment ID: I20240309000751 |
Red Rock Family Practice, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1125 Charles Ave, Worland, WY 82401 Phone: 307-347-2449 Fax: 307-347-6187 | |
Wmc Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1405 Howell Ave, Worland, WY 82401 Phone: 307-347-2555 Fax: 307-347-2597 | |
Cowboy Medical Group Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1125 Charles Ave, Worland, WY 82401 Phone: 307-347-2449 | |
Big Horn Family Medicine Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 316 N 10th St, Worland, WY 82401 Phone: 307-347-8885 Fax: 307-347-2428 | |
Hot Springs County Hospital District Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1125 Charles Ave, Worland, WY 82401 Phone: 307-347-2449 Fax: 855-586-8402 | |
Washakie Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 400 S 15th St, Worland, WY 82401 Phone: 307-347-3221 Fax: 307-347-6937 | |
Frontier Family Practice Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1123 Big Horn Ave, Worland, WY 82401 Phone: 715-610-0200 |