SNAKE RIVER PLASTIC SURGERY LLC (NPI# 1104137074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104137074 |
Entity Type | Organization |
Organization Name | SNAKE RIVER PLASTIC SURGERY LLC |
Practice Address |
555 E. Broadway Suite 212 Jackson WY 83001 |
Mailing Address |
Po Box 2862 Jackson WY 83001-2862 |
Practice Telephone | 3077336077 |
Mailing Telephone | 3077336077 |
Enumeration Date | 2010-06-25 |
Last Update Date | 2010-06-25 |
Authorized Official Name | DR. MICHAEL BARRY GELLIS (MEMBER) |
Authorized Official Telephone | 3077336077 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 174400000X | Specialist | 2735A | WY | Other Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WY | NPI TYPE 1 | 1508997032 | 01 |
Street Address |
555 E. BROADWAY SUITE 212 |
City | JACKSON |
State | WY |
Zip Code | 83001 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023078128 | Robert D. Langer | Family Medicine | 555 E. Broadway, Suite 108, Jackson, WY 83001 | 2006-03-24 |
1376787812 | Biohealth Inc | Clinic/Center | 555 E. Broadway, Ste 210, Jackson, WY 83001 | 2009-04-28 |
1053554162 | Double Rainbow Sciences, LLC | Clinic/Center | 555 E. Broadway, Suite 108, Jackson, WY 83001 | 2009-04-20 |
1437321650 | Jackson Hole Surgery | Surgery | 555 E. Broadway, Suite 212, Jackson, WY 83001 | 2008-03-27 |
1427172279 | Holly Gail Payne | Pediatrics | 555 E. Broadway, Suite 211, Jackson, WY 83001 | 2007-03-19 |
1750466405 | Karin L Klee | Pediatrics | 555 E. Broadway, Suite 216, Jackson, WY 83001 | 2006-10-25 |
1710076849 | Joy Lewis | Internal Medicine | 555 E. Broadway, Suite 216, Jackson, WY 83001 | 2006-10-12 |
1972694545 | William John Ramsay IIi | Specialist | 555 E. Broadway, Suite 214, Jackson, WY 83001-4070 | 2006-09-27 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1861006108 | Anne Kathleen Milburn | Physical Therapist | 3620 S Park Drive, Jackson, WY 83001 | 2020-09-03 |
1568009637 | Katherine Pringle Ford | Case Manager/Care Coordinator | 2065 E. Limber Pine Road, Jackson, WY 83001 | 2019-12-07 |
1043878408 | Cossette Burnham | Physical Therapist | Four Pines Physical Therapy, 1090 S Hwy 89, Jackson, WY 83001 | 2019-05-31 |
1982169371 | Cynthia Buck Huyffer | Social Worker | 755a Cache Creek Drive, Jackson, WY 83001 | 2019-02-10 |
1093281594 | Lara Cilo | Speech-Language Pathologist | 1300 W. Valley Springs Road, Jackson, WY 83001 | 2018-10-23 |
1740776202 | Teton Oral and Maxillofacial Surgery | Dentist | 1160 Alpine Ln Ste 1d, Jackson, WY 83001 | 2018-07-09 |
1437642055 | Anna Yanchek | Physical Therapist | 1090 Us- 89, Jackson Hole, WY 83001 | 2018-06-08 |
1891200762 | Tyler Ross Wright | Chiropractor | 1325 Us-89, Suite 108, Jackson, WY 83001 | 2017-12-13 |
1073027280 | Root To Rise Counseling and Consulting, Pllc | Social Worker | 2033 Dandelion Court, Jackson, WY 83001 | 2017-11-27 |
1962923912 | Piper Worthington | Social Worker | 1910 High School Rd, Jackson, WY 83001 | 2017-06-29 |
Find all providers in zip 83001 |
Taxonomy Code | 174400000X |
Grouping | Other Service Providers |
Classification | Specialist |
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1427656818 | Kimaya Jelks | Specialist | 1869 45 Hwy Bypass, Suite 2b, Jackson, TN 38305 | 2020-10-16 |
1396271565 | Karlisha Britton | Specialist | 7 Lakeland Circle, Suite 300, Jackson, MS 39216 | 2017-05-10 |
1922545896 | Paul Edward Ruttle | Specialist | 2640 Trader Rd, Jackson, WY 83001-8321 | 2017-01-30 |
1780121483 | Andrew Callis | Specialist | 5303 Old Cape Rd E, Jackson, MO 63755-3850 | 2017-01-19 |
1538617055 | Jonathan Parker | Specialist | 95 Riverport Dr, Jackson, TN 38301-5748 | 2016-09-13 |
1386096600 | Miriam Bick | Specialist | 4 Florida Pl, Jackson, NJ 08527-1816 | 2016-07-11 |
1326429572 | Alonzo Roberts | Specialist | 6110 Highway 18 W, Jackson, MS 39209-9322 | 2015-06-13 |
1407289275 | Andrew Francis Charland | Specialist | N168w22224 Main St Ste E, Jackson, WI 53037-9321 | 2013-08-15 |
1265872501 | Robyn Abbott Roberts | Specialist | 1904 Lakeland Dr, Suite D, Jackson, MS 39216-5038 | 2013-07-01 |
1053754580 | Massage Revolution | Specialist | 210 E Capitol St, Ste M-142, Jackson, MS 39201-2306 | 2013-04-15 |
Find all providers in JACKSON |
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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.