Provider Demographics
NPI:1033628599
Name:IVINSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:IVINSON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-755-4603
Mailing Address - Street 1:255 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-5140
Mailing Address - Country:US
Mailing Address - Phone:307-742-2142
Mailing Address - Fax:307-742-2150
Practice Address - Street 1:3116 WILLETT DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-5048
Practice Address - Country:US
Practice Address - Phone:307-742-6319
Practice Address - Fax:307-742-6346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IVINSON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health