Laramie Pediatrics/Laramie Internal Medicine PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

LARAMIE PEDIATRICS/LARAMIE INTERNAL MEDICINE PC

Doing business as

Dell Range Pediatrics

Practice address

1252 N. 22ND Street
Suite B
Laramie, WY 82072

Phone

(307) 745-3704

NPI assigned

Oct 13, 2016

Organization subpart

Yes

Parent organization

LARAMIE PEDIATRICS/LARAMIE INTERNAL MEDICINE PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vijaya Madhavi Koduri, M.D

Title

Owner

Phone

(307) 365-8789

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dell Range Pediatrics Doing business as

Part of

Laramie Urgent Care

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Laramie Pediatrics Internal Medicine

  • Pediatric Adolescent Medicine Physician
  • Laramie, WY
  • NPI 1336215441
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Emily E Baker, DNP, FNP-C

  • Nurse Practitioner
  • Cheyenne, WY
  • NPI 1972339133
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1205386281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1252 N. 22ND STREET",
            "address_2": "SUITE B",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "82072",
            "telephone_number": "307-745-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1252 N. 22ND STREET",
            "address_2": "SUITE B",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "82072",
            "telephone_number": "307-745-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARAMIE PEDIATRICS/LARAMIE INTERNAL MEDICINE PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LARAMIE PEDIATRICS/LARAMIE INTERNAL MEDICINE PC",
        "enumeration_date": "2016-10-13",
        "last_updated": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "KODURI",
        "authorized_official_first_name": "VIJAYA",
        "authorized_official_middle_name": "MADHAVI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-365-8789",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "WY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558672253",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dell Range Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatrics Physician in Laramie, WY
• Providers in Laramie, WY by specialty
• Pediatrics Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.