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General NPI Number Information
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NPI Number | 1386639797
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Entity Type | Organization
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Legal Business Name | CHEYENNE ORTHOPAEDICS, PC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 5320 EDUCATION DR
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City | CHEYENNE
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State | WY
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Zip | 82009-4058
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Country | US
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Telephone | 307-632-9261
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Fax | 307-634-9170
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Provider Business Mailing Address
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Address Line | 5320 EDUCATION DR
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City | CHEYENNE
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State | WY
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Zip | 82009-4058
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Country | US
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Telephone | 307-632-9261
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Fax | 307-634-9170
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Authorized Official
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Title or Position | PARTNER
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Name | JEAN D BASTA
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Credential | MD
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Telephone | 307-263-1773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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