Healthcare Provider Details

I. General information

NPI: 1780738153
Provider Name (Legal Business Name): CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BURMA AVE
GILLETTE WY
82716-3426
US

IV. Provider business mailing address

906 W 6TH ST SUITE C
GILLETTE WY
82716-3435
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-8600
  • Fax:
Mailing address:
  • Phone: 307-688-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number15210
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number15210
License Number StateWY

VIII. Authorized Official

Name: MICHELLE KIOSCHOS
Title or Position: DIRECTOR
Credential: RN
Phone: 307-688-8600