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General NPI Number Information
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NPI Number | 1518947589
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Entity Type | Organization
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Legal Business Name | GEM CITY BONE & JOINT PC
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 1909 VISTA DR
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City | LARAMIE
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State | WY
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Zip | 82070
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Country | US
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Telephone | 307-745-8851
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Fax | 307-742-0961
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Provider Business Mailing Address
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Address Line | 1909 VISTA DR
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City | LARAMIE
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State | WY
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Zip | 82070
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Country | US
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Telephone | 307-745-8851
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Fax | 307-742-0961
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Authorized Official
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Title or Position | DIRECTOR OF HUMAN RESOURCES
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Name | JANA SUAZO
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Credential |
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Telephone | 307-745-8851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 06018
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License Number State | WY
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