Provider Demographics
NPI:1063840775
Name:MEMORIAL HOSPITAL OF SWEETWATER COUNTY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF SWEETWATER COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRE ADMIT REGISTRAR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-352-8136
Mailing Address - Street 1:1200 COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901
Mailing Address - Country:US
Mailing Address - Phone:307-352-8136
Mailing Address - Fax:307-352-8139
Practice Address - Street 1:1200 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901
Practice Address - Country:US
Practice Address - Phone:307-352-8136
Practice Address - Fax:307-352-8139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1558361949OtherNPI