Organization
SURGICAL ASSOCIATES OF NORTHERN WYOMING, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES L JOHNSON II M.D. (PRESIDENT)
(307) 587-1257
Entity
Organization
Contact information
Practice address
1021 9TH ST, CODY, WY 82414-3433
(307) 587-1257
(307) 587-7394
Mailing address
449 MOUNTAIN VIEW ST, POWELL, WY 82435-2232
(307) 754-4559
(307) 754-7733
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00004001
BLUE CROSS BLUE SHIELD
WY
01
—
CJ4682
RAILROAD MEDICARE
WY
Enumeration date
10/14/2005
Last updated
12/06/2007
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