Healthcare Provider Details

I. General information

NPI: 1366510232
Provider Name (Legal Business Name): CROOK COUNTY MEDICAL SERVICES DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 OAK STREET
SUNDANCE WY
82729-0517
US

IV. Provider business mailing address

PO BOX 517 713 OAK STREET
SUNDANCE WY
82729-0517
US

V. Phone/Fax

Practice location:
  • Phone: 307-283-3501
  • Fax: 307-283-2255
Mailing address:
  • Phone: 307-283-3501
  • Fax: 307-283-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number07-100
License Number StateWY

VIII. Authorized Official

Name: MICKI DAHNE LYONS
Title or Position: CEO
Credential: DNP
Phone: 307-283-3501