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General NPI Number Information
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NPI Number | 1063575611
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Entity Type | Organization
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Legal Business Name | CAMPBELL COUNTY HOSPITAL DISTRICT
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 501 S BURMA AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3426
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Country | US
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Telephone | 307-688-1415
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Fax | 307-688-1420
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Provider Business Mailing Address
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Address Line | 501 S BURMA AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3426
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Country | US
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Telephone | 307-688-1415
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Fax | 307-688-1420
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | WILLIAM A FITZGERALD
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Credential |
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Telephone | 307-688-1520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 08-183
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 08-183
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 08-183
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License Number State | WY
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 08-183
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License Number State | WY
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Taxonomy #5
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 08-183
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License Number State | WY
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