Healthcare Provider Details

I. General information

NPI: 1306136205
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF CENTRAL WYOMING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5647 US HWY 26
DUBOIS WY
82513-0577
US

IV. Provider business mailing address

5000 BLACKMORE RD
CASPER WY
82609-3345
US

V. Phone/Fax

Practice location:
  • Phone: 307-455-2516
  • Fax: 307-455-2526
Mailing address:
  • Phone: 307-233-6000
  • Fax: 307-233-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SISCO
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 307-233-6000