1265616171 NPI number — IVINSON MEMORIAL HOSPITAL

Table of content: (NPI 1265616171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265616171 NPI number — IVINSON MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IVINSON MEMORIAL HOSPITAL
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:
IVINSON MEMORIAL 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:
1265616171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 N 30TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARAMIE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82072-5195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-742-2141
Provider Business Mailing Address Fax Number:
307-742-0678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 N 30TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82072-5195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-742-2141
Provider Business Practice Location Address Fax Number:
307-766-9510
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BANDS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
307-755-4603

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  08-186 , 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)





Copyright © 2007-2024 www.npivalidator.com