Organization
CHEYENNE ORTHOPAEDICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN D BASTA MD (PARTNER)
(307) 263-1773
Entity
Organization
Contact information
Practice address
5320 EDUCATION DR, CHEYENNE, WY 82009-4058
(307) 632-9261
(307) 634-9170
Mailing address
5320 EDUCATION DR, CHEYENNE, WY 82009-4058
(307) 632-9261
(307) 634-9170
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2085B0100X
Body Imaging Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0070700I
BLUE CROSS BLUE SHIELD
WY
05
—
109750400
—
WY
01
—
82001A001
TRICARE
WY
01
—
CB4786
RAILROAD MEDICARE
WY
Enumeration date
09/13/2005
Last updated
03/20/2023
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