St John's Surgical Group, PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

5051A Issued in WY

Legal business name

ST JOHN'S SURGICAL GROUP, PC

Practice address

555 E Broadway Ave
Suite 229
Jackson, WY 83001-8640

Phone

(307) 733-0422

Fax

(307) 733-2580

NPI assigned

Dec 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Rosenberg, MD

Title

President

Phone

(307) 733-0422

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411603200000",
    "number": "1356406557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4197",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830014197",
            "telephone_number": "307-733-0422",
            "fax_number": "307-733-2580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE",
            "address_2": "SUITE 229",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-733-0422",
            "fax_number": "307-733-2580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN'S SURGICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2014-09-25",
        "status": "A",
        "authorized_official_last_name": "ROSENBERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "307-733-0422",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "WY",
            "license": "5051A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101117100",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004294400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Christine Somers, M.A., L.M.F.T
• Krysten Gayle Sommerville, OTR
• Starr Marie Sonne, M.ED.; LPC
• Sports and Rehabilitation Center of Wyoming LLC
• Robin Sproule
• Samantha Stasi, MS CF-SLP
• Martha Gene Stearn, MD
• Matthew W Stech, PPC
• Elisa Stephens, NP
• Michael Stern, D.M.D, PHD

• Surgery Physician in Jackson, WY
• Providers in Jackson, WY by specialty
• Surgery Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.