Healthcare Provider Details

I. General information

NPI: 1164621777
Provider Name (Legal Business Name): NORTH BIG HORN HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 LANE 12
LOVELL WY
82431-9537
US

IV. Provider business mailing address

1115 LANE 12
LOVELL WY
82431-9537
US

V. Phone/Fax

Practice location:
  • Phone: 307-548-5200
  • Fax: 307-548-5205
Mailing address:
  • Phone: 307-548-5200
  • Fax: 307-548-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number08-171
License Number StateWY

VIII. Authorized Official

Name: MR. PETER W. BIRKHOLZ
Title or Position: CEO
Credential:
Phone: 307-548-5203