MEDICARE: SOUTH LINCOLN HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	261Q00000X	Clinic/Center
3	207Q00000X	Family Medicine Physician	10314A	WY

General Provider Information

NPI Number	:	1235503459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH LINCOLN HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	195 FEATHER WAY STE 100
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-9352
Country	:	US
Telephone Number	:	307-200-9200
Fax Number	:	307-200-4808

Provider Business Practice Location Address
First Line	:	195 FEATHER WAY STE 100
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-9352
Country	:	US
Telephone Number	:	307-200-9200
Fax Number	:	307-200-4808

Authorized Official
Title or Position	:	CEO
Name	:	KARL E SUNDBERG
Credential	:
Telephone Number	:	307-877-4401

Provider Enumeration Date	:	11/26/2015
Last Update Date	:	03/03/2020

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Directions to “SOUTH LINCOLN HOSPITAL DISTRICT ” Practice Location

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