| Cheyenne Family Medicine | |
|
1950 Bluegrass Cir Suite 200 Cheyenne WY 82009-7323 | |
| (307) 635-5393 | |
| (307) 635-2199 |
| Full Name | Cheyenne Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1950 Bluegrass Cir, Cheyenne, Wyoming |
| Authorized Official Name and Position | Donald A Kougl (PRESIDENT) |
| Authorized Official Contact | 3076355393 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cheyenne Family Medicine Po Box 20170 Cheyenne WY 82003-7004 Ph: (307) 635-5393 | Cheyenne Family Medicine 1950 Bluegrass Cir Suite 200 Cheyenne WY 82009-7323 Ph: (307) 635-5393 |
| NPI Number | 1154342921 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6305750134 |
|---|---|
| Medicare Enrollment ID | O20031117000449 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154342921 | NPI | - | NPPES |
| CN3773 | Other | WY | RAILROAD MEDICARE |
| 112579600 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gabriele L Knierim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366420499 PECOS PAC ID: 7012957004 Enrollment ID: I20050510000166 |
| Provider Name | Julian D Good |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023099637 PECOS PAC ID: 0042108979 Enrollment ID: I20070227000500 |
| Provider Name | Patricia A Zishka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164406781 PECOS PAC ID: 1850458944 Enrollment ID: I20090317000103 |
| Provider Name | Robin M Duncan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386971141 PECOS PAC ID: 7416071782 Enrollment ID: I20100824000801 |
| Provider Name | Lori L Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225361470 PECOS PAC ID: 3779779707 Enrollment ID: I20101202000055 |
| Provider Name | Derek Z Nevins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316189970 PECOS PAC ID: 3274786421 Enrollment ID: I20130121000192 |
| Provider Name | Matthew J Ptaszkiewicz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952367880 PECOS PAC ID: 8820053630 Enrollment ID: I20150108000973 |
| Provider Name | Tharenie Sivarajah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891040630 PECOS PAC ID: 2062656499 Enrollment ID: I20150218000530 |
| Provider Name | Afzal Hussian Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669768305 PECOS PAC ID: 4587808175 Enrollment ID: I20150903000917 |
| Provider Name | Jeremy L Kessler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366705097 PECOS PAC ID: 1052555489 Enrollment ID: I20160108000780 |
| Provider Name | Chere A Bohr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578057196 PECOS PAC ID: 1951651025 Enrollment ID: I20180911002633 |
| Provider Name | Jennifer Boxberger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730682295 PECOS PAC ID: 5890048748 Enrollment ID: I20181023003766 |
| Provider Name | Michael L Snarr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851821995 PECOS PAC ID: 2769717149 Enrollment ID: I20191028003009 |
| Provider Name | Sky J Wolf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174765093 PECOS PAC ID: 5193017101 Enrollment ID: I20191206000630 |
| Provider Name | Jaswinder Singh Sandhu |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386695880 PECOS PAC ID: 3678588910 Enrollment ID: I20200106002648 |
| Provider Name | Kelsie Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184266058 PECOS PAC ID: 1355775917 Enrollment ID: I20200107002756 |
| Provider Name | Rita Barry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588097299 PECOS PAC ID: 9931472982 Enrollment ID: I20200921001340 |
| Provider Name | Hope Ann Ferguson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487147633 PECOS PAC ID: 7911237789 Enrollment ID: I20210125001781 |
Healthreach Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2030 Bluegrass Cir, Cheyenne, WY 82009 Phone: 307-635-3500 Fax: 307-635-2199 | |
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North Cheyenne Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6015 Sycamore Rd, 1st Floor, Cheyenne, WY 82009 Phone: 307-514-1300 | |
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