Healthcare Provider Details

I. General information

NPI: 1427037407
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 TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5201253
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number06108
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number06108
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number06108
License Number StateWY
# 5
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LUKE SENDEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 307-684-5521