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General NPI Number Information
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NPI Number | 1376279059
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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 | 07/26/2022
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 214 E 23RD ST
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City | CHEYENNE
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State | WY
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Zip | 82001-3748
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Country | US
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Telephone | 307-633-7310
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Fax | 307-633-7202
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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 | 307-996-4777
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Fax | 307-773-8013
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT SPECIALIST
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Name | ERIN PETERSEN
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Credential |
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Telephone | 307-432-3664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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