Provider Demographics
NPI:1386639797
Name:CHEYENNE ORTHOPAEDICS, PC
Entity Type:Organization
Organization Name:CHEYENNE ORTHOPAEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BASTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-263-1773
Mailing Address - Street 1:5320 EDUCATION DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4058
Mailing Address - Country:US
Mailing Address - Phone:307-632-9261
Mailing Address - Fax:307-634-9170
Practice Address - Street 1:5320 EDUCATION DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4058
Practice Address - Country:US
Practice Address - Phone:307-632-9261
Practice Address - Fax:307-634-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY82001A001OtherTRICARE
WYCB4786OtherRAILROAD MEDICARE
WY0070700IOtherBLUE CROSS BLUE SHIELD
WY109750400Medicaid