Healthcare Provider Details

I. General information

NPI: 1013057173
Provider Name (Legal Business Name): CASTLE ROCK SPECIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
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

PO BOX 219
GREEN RIVER WY
82935-0219
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 Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

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