Healthcare Provider Details

I. General information

NPI: 1790101947
Provider Name (Legal Business Name): CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 04/15/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 S KENDRICK AVE
GILLETTE WY
82716-4349
US

IV. Provider business mailing address

501 S BURMA AVE
GILLETTE WY
82716-3426
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-8700
  • Fax:
Mailing address:
  • Phone: 307-688-1000
  • Fax: 307-688-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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