=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174524607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOT SPRINGS COUNTY HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2005
-----------------------------------------------------
Last Update Date | 09/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 156 N. 6TH STREET
-----------------------------------------------------
City | BASIN
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82410-0388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-568-2499
-----------------------------------------------------
Fax | 307-568-2699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 388 156 N 6TH STREET
-----------------------------------------------------
City | BASIN
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82410-0388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-568-2499
-----------------------------------------------------
Fax | 307-568-2699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | NATALYA KELLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 307-864-5065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5946A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------