Provider Demographics
NPI:1588691927
Name:CASPER THORACIC MEDICINE, LLP
Entity type:Organization
Organization Name:CASPER THORACIC MEDICINE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-577-0477
Mailing Address - Street 1:940 E 3RD ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3237
Mailing Address - Country:US
Mailing Address - Phone:307-577-0477
Mailing Address - Fax:307-577-0479
Practice Address - Street 1:940 E 3RD ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3237
Practice Address - Country:US
Practice Address - Phone:307-577-0477
Practice Address - Fax:307-577-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW20727Medicare ID - Type UnspecifiedMEDICARE