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NPI Code Detail

MEDICARE: CHEYENNE ORTHOPAEDICS, PC

MEDICARE: CHEYENNE ORTHOPAEDICS, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085B0100XBody Imaging Physician
22085R0202XDiagnostic Radiology Physician
3207X00000XOrthopaedic Surgery Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CB4786OTHERWYRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
182001A001OTHERWYTRICARE
30070700IOTHERWYBLUE CROSS BLUE SHIELD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386639797
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHEYENNE ORTHOPAEDICS, PC
Provider Business Mailing Address
First Line : 5320 EDUCATION DR
Second Line :
City : CHEYENNE
State : WY
Zip : 82009-4058
Country : US
Telephone Number : 307-632-9261
Fax Number : 307-634-9170
Provider Business Practice Location Address
First Line : 5320 EDUCATION DR
Second Line :
City : CHEYENNE
State : WY
Zip : 82009-4058
Country : US
Telephone Number : 307-632-9261
Fax Number : 307-634-9170
Authorized Official
Title or Position : PARTNER
Name : JEAN D BASTA
Credential : MD
Telephone Number : 307-263-1773
Provider Enumeration Date : 09/13/2005
Last Update Date : 03/20/2023

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Directions to “CHEYENNE ORTHOPAEDICS, PC ” Practice Location

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