Healthcare Provider Details

I. General information

NPI: 1073976155
Provider Name (Legal Business Name): CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 W 4TH ST
GILLETTE WY
82716-3327
US

IV. Provider business mailing address

PO BOX 3011
GILLETTE WY
82717-3011
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-4368
  • Fax: 307-688-7935
Mailing address:
  • Phone: 307-688-1000
  • Fax: 307-685-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA922
License Number StateWY

VIII. Authorized Official

Name: MATT SHAHAN
Title or Position: CEO
Credential:
Phone: 307-688-1551