Organization
GEM CITY BONE & JOINT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANA SUAZO (DIRECTOR OF HUMAN RESOURCES)
(307) 745-1415
Entity
Organization
Contact information
Practice address
1909 VISTA DR, LARAMIE, WY 82070-5530
(307) 745-8851
(307) 742-0961
Mailing address
1909 VISTA DR, LARAMIE, WY 82070-5530
(307) 745-8851
(307) 742-0961
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261QR0200X
Radiology Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00832001
BCBS
—
05
—
106251400
—
WY
05
—
106251402
—
WY
05
—
38121263
—
CO
Enumeration date
01/24/2006
Last updated
01/21/2021
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