Healthcare Provider Details

I. General information

NPI: 1013919794
Provider Name (Legal Business Name): SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 SOUTH US HWY 20
BASIN WY
82410-8902
US

IV. Provider business mailing address

388 SOUTH US HWY 20
BASIN WY
82410-8902
US

V. Phone/Fax

Practice location:
  • Phone: 307-568-3311
  • Fax: 307-568-2139
Mailing address:
  • Phone: 307-568-3311
  • Fax: 307-568-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number06-139
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: JOEL JACKSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 307-568-1426