Healthcare Provider Details

I. General information

NPI: 1144989047
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF LARAMIE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 24TH ST
CHEYENNE WY
82001-3126
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-633-7003
  • Fax: 307-633-7818
Mailing address:
  • Phone: 307-996-4777
  • Fax: 307-773-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGARET E. ALLEN
Title or Position: DIRECTOR OF BILLING SERVICES
Credential:
Phone: 307-773-8237