Healthcare Provider Details

I. General information

NPI: 1417031311
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF CARBON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 W ELM ST
RAWLINS WY
82301
US

IV. Provider business mailing address

PO BOX 460
RAWLINS WY
82301-0460
US

V. Phone/Fax

Practice location:
  • Phone: 307-324-2221
  • Fax: 307-324-8368
Mailing address:
  • Phone: 307-324-2221
  • Fax: 307-324-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number08-187
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateWY

VIII. Authorized Official

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