=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386716710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH LINCOLN HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 ONYX ST
-----------------------------------------------------
City | KEMMERER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 83101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-877-4401
-----------------------------------------------------
Fax | 307-877-3236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 ONYX ST
-----------------------------------------------------
City | KEMMERER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 83101-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-877-4401
-----------------------------------------------------
Fax | 307-877-3236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DAVID RYERSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 307-800-8650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 06-148
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------