Healthcare Provider Details

I. General information

NPI: 1124254271
Provider Name (Legal Business Name): SOUTH CENTRAL WYOMING EMS JOINT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 SOUTH RIVER ST #1192
SARATOGA WY
82331-1192
US

IV. Provider business mailing address

PO BOX 1192
SARATOGA WY
82331-1192
US

V. Phone/Fax

Practice location:
  • Phone: 307-326-5052
  • Fax: 307-326-5052
Mailing address:
  • Phone: 307-710-7559
  • Fax: 307-326-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number143
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number142
License Number StateWY

VIII. Authorized Official

Name: STAYTON MOSBEY
Title or Position: DIRECTOR
Credential:
Phone: 307-710-7559