Healthcare Provider Details

I. General information

NPI: 1285854174
Provider Name (Legal Business Name): GLENROCK HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 02/13/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W BIRCH ST
GLENROCK WY
82637-0786
US

IV. Provider business mailing address

925 W BIRCH ST PO BOX 786
GLENROCK WY
82637-0786
US

V. Phone/Fax

Practice location:
  • Phone: 307-436-9206
  • Fax: 307-436-9730
Mailing address:
  • Phone: 307-436-9206
  • Fax: 307-436-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number StateWY

VIII. Authorized Official

Name: MRS. ASHLEY MARIE OVIEDO-LOPEZ
Title or Position: ADMINISTRATOR
Credential: FNPC
Phone: 307-436-9206