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General NPI Number Information
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NPI Number | 1477542231
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF NORTHERN WYOMING, P.C.
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 1021 9TH ST
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City | CODY
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State | WY
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Zip | 82414-3433
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Country | US
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Telephone | 307-587-1257
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Fax | 307-587-7394
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Provider Business Mailing Address
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Address Line | 449 MOUNTAIN VIEW ST
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City | POWELL
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State | WY
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Zip | 82435-2232
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Country | US
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Telephone | 307-754-4559
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Fax | 307-754-7733
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES L JOHNSON II
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Credential | M.D.
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Telephone | 307-587-1257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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