# GEM CITY BONE & JOINT PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518947589
- **Authorized official:** JANA SUAZO (DIRECTOR OF HUMAN RESOURCES)
- **Authorized official phone:** (307) 745-8851

## Contact information

- **Practice address:** 1909 VISTA DR, LARAMIE, WY 82070
- **Practice address phone:** (307) 745-8851
- **Practice address fax:** (307) 742-0961
- **Mailing address:** 1909 VISTA DR, LARAMIE, WY 82070
- **Mailing address phone:** (307) 745-8851
- **Mailing address fax:** (307) 742-0961

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 06018 | WY | Yes |

## Other

- **Enumeration date:** 01/18/2006
- **Last updated:** 01/21/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 106251401 | — | WY |
| 05 | — | 106251403 | — | WY |
| 01 | — | 303849 | BCBS | — |
| 01 | — | 490003442 | RAILROAD MEDICARE | — |