Provider Demographics
NPI:1508929530
Name:BIG HORN BASIN ANESTHESIA
Entity Type:Organization
Organization Name:BIG HORN BASIN ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:F
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:307-578-1860
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-1595
Mailing Address - Country:US
Mailing Address - Phone:307-578-1860
Mailing Address - Fax:307-587-2364
Practice Address - Street 1:726 ALLEN AVE STE B
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3442
Practice Address - Country:US
Practice Address - Phone:307-578-1860
Practice Address - Fax:307-587-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7217.0522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W4600057Medicare PIN