Organization
CUSTOM ORTHOPEDICS OF WYO. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY O JACKSON (OFFICE MANAGER)
(307) 237-3688
Entity
Organization
Contact information
Practice address
240 W 9TH ST, CASPER, WY 82601-3708
(307) 237-3688
(307) 237-3696
Mailing address
240 W 9TH ST, CASPER, WY 82601-3708
(307) 237-3688
(307) 237-3696
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025302700
—
NE
Enumeration date
06/18/2006
Last updated
08/22/2020
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