Healthcare Provider Details

I. General information

NPI: 1285621839
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF LARAMIE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E 23RD ST
CHEYENNE WY
82001-3748
US

IV. Provider business mailing address

214 E 23RD ST
CHEYENNE WY
82001-3748
US

V. Phone/Fax

Practice location:
  • Phone: 307-634-2273
  • Fax: 307-633-3018
Mailing address:
  • Phone: 307-634-2273
  • Fax: 307-633-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number06-201
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number06-201
License Number StateWY
# 5
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number06-201
License Number StateWY
# 6
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06-115
License Number StateWY

VIII. Authorized Official

Name: BRAD WHITE
Title or Position: REVENUE CYCLE ADMINISTRATOR
Credential:
Phone: 307-633-6198