Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Snake River Plastic Surgery LLC

Organization Specialist · NPI 1104137074

Snake River Plastic Surgery LLC is a Specialist in Jackson, Wyoming. Licensed in Wyoming. Registered with an NPI since 2010.

Licensed in
WY
In the registry since
2010
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

555 E Broadway Ste 212
Jackson, WY 83001
Phone: (307) 733-6077
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 2735A (WY)

Record details

NPI number1104137074
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Michael Gellis — Member · (307) 733-6077
NPI enumeratedJune 25, 2010
Last updated in NPPESJune 25, 2010
Mailing addressPo Box 2862, Jackson, WY 83001-2862

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