Basic Information
| Provider Information | |||||||||
| NPI: | 1386639797 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHEYENNE ORTHOPAEDICS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 HOUSE AVE | ||||||||
| Address2: | STE 505 | ||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820013179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076329261 | ||||||||
| FaxNumber: | 3076349170 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 HOUSE AVE | ||||||||
| Address2: | STE 505 | ||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820013179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076329261 | ||||||||
| FaxNumber: | 3076349170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | TORKELSON | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3076329261 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | CB4786 | 01 | WY | RAILROAD MEDICARE | OTHER | 0070700I | 01 | WY | BLUE CROSS BLUE SHIELD | OTHER | 82001A001 | 01 | WY | TRICARE | OTHER |