1013919794 NPI number — SOUTH BIG HORN COUNTY HOSPITAL DISTRICT

Table of content: (NPI 1013919794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013919794 NPI number — SOUTH BIG HORN COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH BIG HORN COUNTY HOSPITAL 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:
SOUTH BIG HORN COUNTY CRITICAL ACCESS HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1013919794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
388 SOUTH US HWY 20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BASIN
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82410-8902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-568-3311
Provider Business Mailing Address Fax Number:
307-568-2139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
388 SOUTH US HWY 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BASIN
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82410-8902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-568-3311
Provider Business Practice Location Address Fax Number:
307-568-2139
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
307-568-1426

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 06-139 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116049400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7385 . This is a "BLUECROSS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 007385 . This is a "BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 116049401 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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