Provider Demographics
NPI:1336215441
Name:LARAMIE PEDIATRICS INTERNAL MEDICINE
Entity Type:Organization
Organization Name:LARAMIE PEDIATRICS INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:KLEPPINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-745-3704
Mailing Address - Street 1:1252 NORTH 22ND ST
Mailing Address - Street 2:STE B
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072
Mailing Address - Country:US
Mailing Address - Phone:307-745-3704
Mailing Address - Fax:307-745-7237
Practice Address - Street 1:1252 NORTH 22ND ST
Practice Address - Street 2:STE B
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072
Practice Address - Country:US
Practice Address - Phone:307-745-3704
Practice Address - Fax:307-745-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY124413200Medicaid