MEDICARE: CROOK COUNTY MEDICAL SERVICES DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447328638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROOK COUNTY MEDICAL SERVICES DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 517
Second Line	:	713 OAK STREET
City	:	SUNDANCE
State	:	WY
Zip	:	82729-0517
Country	:	US
Telephone Number	:	307-283-3501
Fax Number	:	307-283-2255

Provider Business Practice Location Address
First Line	:	208 N BIG HORN AVE
Second Line	:
City	:	MOORCROFT
State	:	WY
Zip	:	82721
Country	:	US
Telephone Number	:	307-756-3474
Fax Number	:	307-283-2255

Authorized Official
Title or Position	:	CEO
Name	:	MICKI DAHNE LYONS
Credential	:	DNP
Telephone Number	:	307-283-3501

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	10/16/2020

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Directions to “CROOK COUNTY MEDICAL SERVICES DISTRICT ” Practice Location

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