MEDICARE: WELLINGTON MEDICAL CENTER LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1801908900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLINGTON MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	214 E 23RD ST
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-3748
Country	:	US
Telephone Number	:	307-633-3096
Fax Number	:	307-633-3019

Provider Business Practice Location Address
First Line	:	7859 6TH ST
Second Line	:
City	:	WELLINGTON
State	:	CO
Zip	:	80549-1500
Country	:	US
Telephone Number	:	970-568-4800
Fax Number	:	970-568-4165

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. CHARLES F HARMS
Credential	:
Telephone Number	:	307-633-7600

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/15/2007

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Directions to “WELLINGTON MEDICAL CENTER LLC ” Practice Location

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