MEDICARE: SWEETWATER COUNTY DISTRICT BOARD OF HEALTH

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	251E00000X	Home Health Agency	10289	WY

General Provider Information

NPI Number	:	1629399902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEETWATER COUNTY DISTRICT BOARD OF HEALTH

Provider Business Mailing Address
First Line	:	731 C ST STE 315
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-6231
Country	:	US
Telephone Number	:	307-922-5390
Fax Number	:	307-922-5496

Provider Business Practice Location Address
First Line	:	731 C ST
Second Line	:	SUITE 315
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-6202
Country	:	US
Telephone Number	:	307-922-5390
Fax Number	:	307-922-5496

Authorized Official
Title or Position	:	INTERIM COUNTY MANAGER
Name	:	JANET LYNN GERKEN
Credential	:	R.N.
Telephone Number	:	307-922-5390

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/21/2010

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