Healthcare Provider Details

I. General information

NPI: 1750485793
Provider Name (Legal Business Name): NORTH BIG HORN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/05/2019
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: 307-548-5201
  • Fax: 307-548-5224
Mailing address:
  • Phone: 307-548-5201
  • Fax: 307-548-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number07-128
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number07-128
License Number StateWY

VIII. Authorized Official

Name: MR. RICKY A. SCHROEDER
Title or Position: CEO
Credential:
Phone: 307-548-5203