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General NPI Number Information
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NPI Number | 1811264732
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Entity Type | Organization
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Legal Business Name | CAMPBELL COUNTY HOSPITAL DISTRICT
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 501 S BURMA AVE 3N-NEURO
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City | GILLETTE
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State | WY
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Zip | 82716-3426
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Country | US
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Telephone | 307-688-3500
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Fax | 307-688-3510
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Provider Business Mailing Address
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Address Line | PO BOX 3011
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City | GILLETTE
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State | WY
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Zip | 82717-3011
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Country | US
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Telephone | 307-688-3500
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Fax | 307-688-3510
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | WILLIAM A FITZGERALD
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Credential |
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Telephone | 307-688-1520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 8793A
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License Number State | WY
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