Unknown Individual – Anesthesiology Physician, NPI 1366925539

Unknown Individual is a healthcare provider. based in Delta, Utah. specializing in Anesthesiology Physician. They hold a License No. 41809.1798 (WY). The NPI Number for Unknown Individual is 1366925539

Main info

Organization
Inactive
8 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1366925539
Phone
Not provided
Address
PO BOX 100
Deactivation Date
13 March 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7753294600
Graduation Year
2018 (8 years ago)
PAC ID
3375887243
Group Practice PAC ID
0941107478
Professional Enrollment ID
I20200302002288
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Delta County Federal Credit Union, 100, Circle Drive, Delta, Delta County, Colorado, 81416, United States

    DELTA, UT 846240100

    Phone:

    Type: Mailing

  • Campbell County Health, 501, South Burma Avenue, Gillette, Campbell County, Wyoming, 82716, United States

    GILLETTE, WY 827163426

    Phone: (307) 688-1824

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 84624)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0941107478View full group profile
NameSpecialtyState
Internal Medicine, GastroenterologyNV
G A S T R O E N T E R O L O G YNV
Certified Registered Nurse Anesthetist (Crna)NV
Nurse PractitionerNV
Nurse PractitionerNV
P A T H O L O G YNV
Nurse PractitionerNV
-NV
Certified Registered Nurse Anesthetist (Crna)WY
Certified Registered Nurse Anesthetist (Crna)FL

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1366925539 in the public NPI dataset.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Anesthesiology Physician in this dataset. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Delta, Utah may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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