Provider Demographics
NPI:1225224231
Name:COUNTY OF CAMPBELL
Entity Type:Organization
Organization Name:COUNTY OF CAMPBELL
Other - Org Name:CAMPBELL COUNTY PUIBLIC HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:G
Authorized Official - Last Name:AMEND
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BC
Authorized Official - Phone:307-682-7274
Mailing Address - Street 1:PO BOX 3420
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3420
Mailing Address - Country:US
Mailing Address - Phone:307-682-7275
Mailing Address - Fax:307-682-0374
Practice Address - Street 1:2301 SOUTH 4J RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718
Practice Address - Country:US
Practice Address - Phone:307-682-7275
Practice Address - Fax:307-682-0374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY08-079251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW308141Medicare PIN