Healthcare Provider Details

I. General information

NPI: 1144313255
Provider Name (Legal Business Name): CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/20/2017
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

501 S BURMA AVE
GILLETTE WY
82716-3426
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-1415
  • Fax: 307-688-1420
Mailing address:
  • Phone: 307-688-1415
  • Fax: 307-688-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number06-210
License Number StateWY

VIII. Authorized Official

Name: DALTON HUBER
Title or Position: CFO
Credential:
Phone: 307-688-1523