1689691503 NPI number — COUNTY OF FREMONT

Table of content: (NPI 1689691503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689691503 NPI number — COUNTY OF FREMONT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF FREMONT
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:
1689691503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 N 2ND ST
Provider Second Line Business Mailing Address:
RM 350
Provider Business Mailing Address City Name:
LANDER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82520-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-332-1073
Provider Business Mailing Address Fax Number:
307-332-1064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 N 2ND ST
Provider Second Line Business Practice Location Address:
RM 350
Provider Business Practice Location Address City Name:
LANDER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82520-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-332-1073
Provider Business Practice Location Address Fax Number:
307-332-1064
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEHR
Authorized Official First Name:
JO
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATIVE EXECUTIVE
Authorized Official Telephone Number:
307-856-6979

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251K00000X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 107247100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com