Provider Demographics
NPI:1134272917
Name:CASPER OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:CASPER OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-234-6988
Mailing Address - Street 1:150 NORTH MELROSE ST.
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2735
Mailing Address - Country:US
Mailing Address - Phone:307-234-6988
Mailing Address - Fax:307-472-2854
Practice Address - Street 1:150 NORTH MELROSE ST.
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2735
Practice Address - Country:US
Practice Address - Phone:307-234-6988
Practice Address - Fax:307-472-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW4371034OtherRAILROAD MEDICARE
WY1134272917Medicaid
WYW4371034OtherRAILROAD MEDICARE