Organization
YELLOWSTONE SPORTS MEDICINE, LLC
Active
Organization
YELLOWSTONE SPORTS MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMIE G BILES M.D. (OWNER)
(307) 578-1949
Entity
Organization
Contact information
Practice address
720 LINDSAY LN, CODY, WY 82414-4103
(307) 578-1953
(307) 578-1956
Mailing address
720 LINDSAY LN, CODY, WY 82414-4103
(307) 578-1953
(307) 578-1956
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
3909A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000082971
MEDICARE
MT
05
—
102410800
—
WY
01
—
200009940
MEDICARE RAILROAD
WY
05
—
297555
—
OR
01
—
302474
BLUE CROSS BLUE SHIELD
WY
05
—
3505047
—
MT
05
—
MD323WY
—
AK
Enumeration date
06/01/2016
Last updated
06/01/2016
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