Healthcare Provider Details

I. General information

NPI: 1992874218
Provider Name (Legal Business Name): CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
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: 307-688-3333
  • Fax: 307-688-3336
Mailing address:
  • Phone: 307-688-1000
  • Fax: 307-688-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5201126
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW SHAHAN
Title or Position: CEO
Credential:
Phone: 307-688-1502