Healthcare Provider Details

I. General information

NPI: 1518947589
Provider Name (Legal Business Name): GEM CITY BONE & JOINT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 VISTA DR
LARAMIE WY
82070
US

IV. Provider business mailing address

1909 VISTA DR
LARAMIE WY
82070
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-8851
  • Fax: 307-742-0961
Mailing address:
  • Phone: 307-745-8851
  • Fax: 307-742-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number06018
License Number StateWY

VIII. Authorized Official

Name: JANA SUAZO
Title or Position: DIRECTOR OF HUMAN RESOURCES
Credential:
Phone: 307-745-8851