Provider Demographics
NPI:1114333127
Name:CASPER CHILDREN'S CENTER, LLC
Entity Type:Organization
Organization Name:CASPER CHILDREN'S CENTER, LLC
Other - Org Name:CASPER CHILDREN'S CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ORGANIZING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:CYPHER
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-685-6709
Mailing Address - Street 1:2222 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2060
Mailing Address - Country:US
Mailing Address - Phone:307-577-4260
Mailing Address - Fax:307-577-4263
Practice Address - Street 1:2222 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2060
Practice Address - Country:US
Practice Address - Phone:307-577-4260
Practice Address - Fax:307-577-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9791A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY137748500Medicaid