Provider Demographics
NPI:1134249725
Name:BIG HORN BASIN BONE & JOINT, LLC
Entity type:Organization
Organization Name:BIG HORN BASIN BONE & JOINT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-527-3345
Mailing Address - Street 1:3030 BIG HORN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9208
Mailing Address - Country:US
Mailing Address - Phone:307-578-1955
Mailing Address - Fax:307-578-1957
Practice Address - Street 1:3030 BIG HORN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-578-1955
Practice Address - Fax:307-578-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5991450001Medicare NSC
WY10503Medicare PIN