Healthcare Provider Details

I. General information

NPI: 1851472955
Provider Name (Legal Business Name): CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH BURMA AVENUE
GILLETTE WY
82716
US

IV. Provider business mailing address

PO BOX 3011
GILLETTE WY
82717-3011
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-6230
  • Fax: 307-688-6210
Mailing address:
  • Phone: 307-688-6230
  • Fax: 307-688-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number07034
License Number StateWY

VIII. Authorized Official

Name: WILLIAM ANDREW FITZGERALD
Title or Position: CEO
Credential:
Phone: 307-688-1521