Provider Demographics
NPI:1760471726
Name:ABSAROKA ORTHOPEDICS
Entity Type:Organization
Organization Name:ABSAROKA ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINZENRIED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-754-7257
Mailing Address - Street 1:424 YELLOWSTONE AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9318
Mailing Address - Country:US
Mailing Address - Phone:307-527-7100
Mailing Address - Fax:307-527-7145
Practice Address - Street 1:424 YELLOWSTONE AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9318
Practice Address - Country:US
Practice Address - Phone:307-527-7100
Practice Address - Fax:307-527-7145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
WY4931310001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY01201001OtherBLUE CROSS BLUE SHEILD
WY115812100Medicaid
WYDB2917OtherRAILROAD MEDICARE
WY4931310001OtherDME MEDICARE
WY115812100Medicaid
WYDB2917Medicare PIN
WY01201001OtherBLUE CROSS BLUE SHEILD