Healthcare Provider Details

I. General information

NPI: 1285643221
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF CONVERSE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 5TH ST
DOUGLAS WY
82633-2434
US

IV. Provider business mailing address

111 S 5TH ST P.O. BOX 1450
DOUGLAS WY
82633-2434
US

V. Phone/Fax

Practice location:
  • Phone: 307-358-2122
  • Fax: 307-358-9216
Mailing address:
  • Phone: 307-358-2122
  • Fax: 307-358-9216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number07163
License Number StateWY

VIII. Authorized Official

Name: MR. CURT DUGGER
Title or Position: CFO
Credential:
Phone: 307-358-2122