1871660159 NPI number — CROOK COUNTY MEDICAL SERVICES DISTRICT

Table of content: (NPI 1871660159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871660159 NPI number — CROOK COUNTY MEDICAL SERVICES DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROOK COUNTY MEDICAL SERVICES DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CROOK COUNTY MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871660159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
713 OAK STREET
Provider Second Line Business Mailing Address:
PO BOX 517
Provider Business Mailing Address City Name:
SUNDANCE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82729-0517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-283-3501
Provider Business Mailing Address Fax Number:
307-283-2255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
713 OAK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNDANCE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82729-0517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-283-3501
Provider Business Practice Location Address Fax Number:
307-283-2255
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LYONS
Authorized Official First Name:
MICKI
Authorized Official Middle Name:
DAHNE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
307-283-3501

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  07-127 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 313M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106168200 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106168202 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106168211 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106168203 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106168204 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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