Provider Demographics
NPI:1194837658
Name:ASSOCIATED PODIATRISTS, P.C.
Entity Type:Organization
Organization Name:ASSOCIATED PODIATRISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:307-778-7666
Mailing Address - Street 1:2029 BLUEGRASS CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7368
Mailing Address - Country:US
Mailing Address - Phone:307-778-7666
Mailing Address - Fax:307-632-4465
Practice Address - Street 1:2029 BLUEGRASS CIR
Practice Address - Street 2:STE 200
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7368
Practice Address - Country:US
Practice Address - Phone:307-778-7666
Practice Address - Fax:307-632-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYW59213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117602100Medicaid
WYW9359Medicare ID - Type UnspecifiedGROUP # FOR PRACTICE
WY4523560001Medicare NSC