Provider Demographics
NPI:1215335179
Name:CASPER GENERAL SURGERY, LLC
Entity type:Organization
Organization Name:CASPER GENERAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMOTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-337-4981
Mailing Address - Street 1:940 E 3RD ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3237
Mailing Address - Country:US
Mailing Address - Phone:307-337-4981
Mailing Address - Fax:
Practice Address - Street 1:940 E 3RD ST
Practice Address - Street 2:SUITE 215
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3237
Practice Address - Country:US
Practice Address - Phone:307-337-4981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty