Healthcare Provider Details

I. General information

NPI: 1134249725
Provider Name (Legal Business Name): BIG HORN BASIN BONE & JOINT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 8TH ST
CODY WY
82414-4136
US

IV. Provider business mailing address

1728 8TH ST
CODY WY
82414-4136
US

V. Phone/Fax

Practice location:
  • Phone: 307-578-1955
  • Fax: 307-578-1996
Mailing address:
  • Phone: 307-578-1955
  • Fax: 307-578-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateWY

VIII. Authorized Official

Name: KODY DEMUNBRUN
Title or Position: MANAGER
Credential:
Phone: 307-578-1955