Healthcare Provider Details

I. General information

NPI: 1740206382
Provider Name (Legal Business Name): CASTLE ROCK SPECIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 UINTA DR
GREEN RIVER WY
82935-5046
US

IV. Provider business mailing address

1400 UINTA DR
GREEN RIVER WY
82935-5060
US

V. Phone/Fax

Practice location:
  • Phone: 307-872-4500
  • Fax: 307-872-4595
Mailing address:
  • Phone: 307-872-4500
  • Fax: 307-872-4595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateWY

VIII. Authorized Official

Name: MS. SUSAN BYBEE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 307-872-4530