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: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 BIG HORN AVE
CODY WY
82414
US

IV. Provider business mailing address

3030 BIG HORN AVE
CODY WY
82414-9208
US

V. Phone/Fax

Practice location:
  • Phone: 307-578-1955
  • Fax: 307-578-1957
Mailing address:
  • Phone: 307-578-1955
  • Fax: 307-578-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateWY

VIII. Authorized Official

Name: LESLIE KARLIK
Title or Position: CREDENTIALING
Credential:
Phone: 307-527-3345