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General NPI Number Information
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NPI Number | 1679582357
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL OF CONVERSE COUNTY
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 525 EAST BIRCH STREET
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City | GLENROCK
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State | WY
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Zip | 82637
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Country | US
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Telephone | 307-436-8838
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Fax | 307-436-2476
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Provider Business Mailing Address
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Address Line | PO BOX 1450
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City | DOUGLAS
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State | WY
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Zip | 82633-1450
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Country | US
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Telephone | 307-358-2122
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Fax | 307-358-9216
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Authorized Official
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Title or Position | CFO
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Name | MR. CURT DUGGER
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Credential |
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Telephone | 307-358-2122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 07163
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License Number State | WY
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