Healthcare Provider Details

I. General information

NPI: 1801908900
Provider Name (Legal Business Name): WELLINGTON MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7859 6TH ST
WELLINGTON CO
80549-1500
US

IV. Provider business mailing address

214 E 23RD ST
CHEYENNE WY
82001-3748
US

V. Phone/Fax

Practice location:
  • Phone: 970-568-4800
  • Fax: 970-568-4165
Mailing address:
  • Phone: 307-633-3096
  • Fax: 307-633-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES F HARMS
Title or Position: MANAGER
Credential:
Phone: 307-633-7600