Healthcare Provider Details

I. General information

NPI: 1760471726
Provider Name (Legal Business Name): ABSAROKA ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 YELLOWSTONE AVE SUITE 140
CODY WY
82414-9318
US

IV. Provider business mailing address

424 YELLOWSTONE AVE SUITE 140
CODY WY
82414-9318
US

V. Phone/Fax

Practice location:
  • Phone: 307-527-7100
  • Fax: 307-527-7145
Mailing address:
  • Phone: 307-527-7100
  • Fax: 307-527-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4931310001
License Number StateWY

VIII. Authorized Official

Name: JAY A WINZENRIED
Title or Position: PRESIDENT
Credential: M.D.
Phone: 307-754-7257