Healthcare Provider Details

I. General information

NPI: 1073673042
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF CENTRAL WYOMING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date: 10/25/2016
Reactivation Date: 11/15/2016

III. Provider practice location address

5000 BLACKMORE RD
CASPER WY
82609-3345
US

IV. Provider business mailing address

5000 BLACKMORE RD
CASPER WY
82609-3345
US

V. Phone/Fax

Practice location:
  • Phone: 307-233-6050
  • Fax: 307-233-6087
Mailing address:
  • Phone: 307-233-6050
  • Fax: 307-233-6087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number5201621
License Number StateWY

VIII. Authorized Official

Name: JESSICA DORNBIER
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 307-233-6050