1629399902 NPI number — SWEETWATER COUNTY DISTRICT BOARD OF HEALTH

Table of content: (NPI 1629399902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629399902 NPI number — SWEETWATER COUNTY DISTRICT BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWEETWATER COUNTY DISTRICT BOARD OF HEALTH
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:
Provider Other Organization Name Type Code:
6
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:
1629399902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
731 C ST STE 315
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK SPRINGS
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82901-6231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-922-5390
Provider Business Mailing Address Fax Number:
307-922-5496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
731 C ST
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
ROCK SPRINGS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82901-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-922-5390
Provider Business Practice Location Address Fax Number:
307-922-5496
Provider Enumeration Date:
06/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GERKEN
Authorized Official First Name:
JANET
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
INTERIM COUNTY MANAGER
Authorized Official Telephone Number:
307-922-5390

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  10289 , 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)





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