Provider Demographics
NPI:1073976155
Name:CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CAMPBELL COUNTY HOSPITAL DISTRICT
Other - Org Name:CAMPBELL COUNTY MEDICAL GROUP AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-688-1520
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3046
Mailing Address - Country:US
Mailing Address - Phone:307-688-2600
Mailing Address - Fax:307-685-3079
Practice Address - Street 1:1901 ENERGY CT
Practice Address - Street 2:STE 140
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5522
Practice Address - Country:US
Practice Address - Phone:307-688-4368
Practice Address - Fax:307-685-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA922231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty