Healthcare Provider Details

I. General information

NPI: 1881639144
Provider Name (Legal Business Name): CAMPBELL COUNTY MEMORIAL HOSPITAL HOME MEDICAL RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 W HIGHWAY 14-16
GILLETTE WY
82716-3342
US

IV. Provider business mailing address

1708 W HIGHWAY 14-16
GILLETTE WY
82716-3342
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-6260
  • Fax: 307-688-6265
Mailing address:
  • Phone: 307-688-6260
  • Fax: 307-688-6265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number17004748
License Number StateWY

VIII. Authorized Official

Name: MR. ANDY FITZGERALD
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 307-688-1520