Healthcare Provider Details

I. General information

NPI: 1134666944
Provider Name (Legal Business Name): EVANSTON HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N MAIN STREET
LYMAN WY
82937-0001
US

IV. Provider business mailing address

107 N MAIN STREET
LYMAN WY
82937-0001
US

V. Phone/Fax

Practice location:
  • Phone: 307-787-3313
  • Fax: 307-787-3312
Mailing address:
  • Phone: 307-787-3313
  • Fax: 307-787-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number15107
License Number StateWY

VIII. Authorized Official

Name: LAURA J FEY
Title or Position: SR. DIRECTOR PHYSICIAN REV CYCLE
Credential:
Phone: 615-221-3641