1043200041 NPI number — WEST PARK HOSPITAL DISTRICT

Table of content: (NPI 1043200041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043200041 NPI number — WEST PARK HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST PARK 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:
CODY REGIONAL HEALTH WALK IN CLINIC
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:
1043200041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 SHERIDAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CODY
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-578-2480
Provider Business Mailing Address Fax Number:
307-578-2492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 YELLOWSTONE AVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
CODY
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-578-2907
Provider Business Practice Location Address Fax Number:
307-587-1256
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCMILLAN
Authorized Official First Name:
DOUGALS
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
307-578-2489

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  06-003 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106133017 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1081001 . This is a "BLUE CROSS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 307718 . This is a "BLUE CROSS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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