Healthcare Provider Details

I. General information

NPI: 1851319883
Provider Name (Legal Business Name): COUNTY OF CARBON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BUFFALO ST. SUITE 139, CARBON BLDG.
RAWLLINS WY
82301
US

IV. Provider business mailing address

P.O. BOX 1013
RAWLINS WY
82301
US

V. Phone/Fax

Practice location:
  • Phone: 307-328-2607
  • Fax: 307-328-2602
Mailing address:
  • Phone: 307-328-2607
  • Fax: 307-328-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number07-185
License Number StateWY

VIII. Authorized Official

Name: BRIDGET HETTGAR
Title or Position: COUNTY MANAGER
Credential: RN
Phone: 307-328-2607