Healthcare Provider Details

I. General information

NPI: 1255368593
Provider Name (Legal Business Name): WASHAKIE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 15TH ST
WORLAND WY
82401-3531
US

IV. Provider business mailing address

2901 N CENTRAL AVE STE 160
PHOENIX AZ
85012-2702
US

V. Phone/Fax

Practice location:
  • Phone: 307-347-3221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number06196
License Number StateWY

VIII. Authorized Official

Name: LISA VAN BRUNT
Title or Position: CEO
Credential:
Phone: 307-347-3221