Healthcare Provider Details

I. General information

NPI: 1205547742
Provider Name (Legal Business Name): CAMPBELL COUNTY HOSPITAL DISTRICT,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BURMA AVE
GILLETTE WY
82716-3426
US

IV. Provider business mailing address

500 ROSS ST 154-0455 PO BOX 392967
PITTSBURGH PA
15251-9967
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-0110
  • Fax: 307-688-0111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS ADAM POPP
Title or Position: CFO
Credential:
Phone: 307-688-1523