Healthcare Provider Details

I. General information

NPI: 1992784961
Provider Name (Legal Business Name): JOHNSON COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 WEST LOTT
BUFFALO WY
82834-1609
US

IV. Provider business mailing address

497 WEST LOTT
BUFFALO WY
82834-1609
US

V. Phone/Fax

Practice location:
  • Phone: 307-684-5521
  • Fax: 307-684-5385
Mailing address:
  • Phone: 307-684-5521
  • Fax: 307-684-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number06049
License Number StateWY

VIII. Authorized Official

Name: MR. LUKE SENDEN
Title or Position: CEO
Credential:
Phone: 307-684-6188