Provider Demographics
NPI:1740200294
Name:SHERIDAN ORTHOPAEDIC ASSOCIATES, P C
Entity Type:Organization
Organization Name:SHERIDAN ORTHOPAEDIC ASSOCIATES, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAGORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-673-1813
Mailing Address - Street 1:1050 MYDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2186
Mailing Address - Country:US
Mailing Address - Phone:307-673-1813
Mailing Address - Fax:307-674-4619
Practice Address - Street 1:1050 MYDLAND RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2186
Practice Address - Country:US
Practice Address - Phone:307-673-1813
Practice Address - Fax:307-674-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106243300Medicaid
WY106243300Medicaid
WY106243300Medicaid