Healthcare Provider Details

I. General information

NPI: 1841126687
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF CONVERSE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 5TH ST
DOUGLAS WY
82633-2434
US

IV. Provider business mailing address

PO BOX 1450
DOUGLAS WY
82633-1450
US

V. Phone/Fax

Practice location:
  • Phone: 307-358-2122
  • Fax:
Mailing address:
  • Phone: 307-358-2122
  • Fax: 307-358-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DAMMEYER
Title or Position: CEO
Credential:
Phone: 307-358-2122