Healthcare Provider Details

I. General information

NPI: 1194869115
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF CARBON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 FELDSPAR COURT
HANNA WY
82327
US

IV. Provider business mailing address

PO BOX 689
HANNA WY
82327-0689
US

V. Phone/Fax

Practice location:
  • Phone: 307-325-6596
  • Fax: 307-325-6597
Mailing address:
  • Phone: 307-325-6596
  • Fax: 307-325-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2916A
License Number StateWY

VIII. Authorized Official

Name: MICHELLE KEPLINGER
Title or Position: CFO
Credential:
Phone: 307-324-8347