Provider Demographics
NPI:1558454819
Name:ROCKY MOUNTAIN ORTHOPEDIC SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN ORTHOPEDIC SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:W. CARLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:RECKLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-632-6637
Mailing Address - Street 1:800 E 20TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3859
Mailing Address - Country:US
Mailing Address - Phone:307-632-6637
Mailing Address - Fax:307-632-3382
Practice Address - Street 1:800 E 20TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3859
Practice Address - Country:US
Practice Address - Phone:307-632-6637
Practice Address - Fax:307-632-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116389200Medicaid
WY116389200Medicaid