Healthcare Provider Details

I. General information

NPI: 1447512959
Provider Name (Legal Business Name): CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 STOCKTRAIL AVE STE A
GILLETTE WY
82716-3582
US

IV. Provider business mailing address

508 STOCKTRAIL AVE STE A
GILLETTE WY
82716-3582
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-1413
  • Fax: 307-682-1113
Mailing address:
  • Phone: 307-686-1413
  • Fax: 307-682-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateWY

VIII. Authorized Official

Name: KELLEY UNDERWOOD
Title or Position: PATIENT FINANCIAL SERVICES MANAGER
Credential:
Phone: 307-688-1492