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General NPI Number Information
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NPI Number | 1194642736
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL OF LARAMIE COUNTY
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Dates
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Enumeration Date | 07/03/2026
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Last Update Date | 07/03/2026
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Provider Practice Location Address
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Address Line | 1950 BLUEGRASS CIR STE 200
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City | CHEYENNE
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State | WY
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Zip | 82009-7364
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Country | US
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Telephone | 307-778-2577
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Fax | 307-635-2131
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Provider Business Mailing Address
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Address Line | PO BOX 20970
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City | CHEYENNE
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State | WY
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Zip | 82003-7020
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Country | US
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Telephone | 307-778-2577
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Fax | 307-635-2131
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Authorized Official
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Title or Position | ADMINISTRATOR OF REVENUE
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Name | BRAD WHITE
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Credential |
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Telephone | 307-633-6198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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