Provider Demographics
NPI:1043200041
Name:WEST PARK HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WEST PARK HOSPITAL DISTRICT
Other - Org Name:CODY REGIONAL HEALTH WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGALS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-578-2489
Mailing Address - Street 1:707 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414
Mailing Address - Country:US
Mailing Address - Phone:307-578-2480
Mailing Address - Fax:307-578-2492
Practice Address - Street 1:424 YELLOWSTONE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-578-2907
Practice Address - Fax:307-587-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY06-003261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106133017Medicaid
WY1081001OtherBLUE CROSS
WY307718OtherBLUE CROSS
WY531312Medicare Oscar/Certification
WY307718OtherBLUE CROSS