1285657007 NPI number — NORTH LINCOLN COUNTY HOSPITAL DISTRICT

Table of content: (NPI 1285657007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285657007 NPI number — NORTH LINCOLN COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH LINCOLN 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:
STAR VALLEY MEDICAL CENTER EMTS
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:
1285657007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 579
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AFTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
83110-0579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-885-5800
Provider Business Mailing Address Fax Number:
307-885-5865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 ADAMS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AFTON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
83110-0579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-885-5800
Provider Business Practice Location Address Fax Number:
307-885-5865
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEBDON
Authorized Official First Name:
DEIRDRE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
307-885-5811

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  01 , 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: 1285657007 . This is a "MEDICARE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1285657007 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255376406 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com