Healthcare Provider Details

I. General information

NPI: 1043200041
Provider Name (Legal Business Name): WEST PARK HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 YELLOWSTONE AVE SUITE 120
CODY WY
82414
US

IV. Provider business mailing address

707 SHERIDAN AVE
CODY WY
82414
US

V. Phone/Fax

Practice location:
  • Phone: 307-578-2907
  • Fax: 307-587-1256
Mailing address:
  • Phone: 307-578-2480
  • Fax: 307-578-2492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number06-003
License Number StateWY

VIII. Authorized Official

Name: DOUGALS ALAN MCMILLAN
Title or Position: CEO
Credential:
Phone: 307-578-2489