Provider Demographics
NPI:1275674608
Name:CITY OF CASPER-NATRONA COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CITY OF CASPER-NATRONA COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE OPERATIONS FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-577-9723
Mailing Address - Street 1:475 S. SPRUCE ST.
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1759
Mailing Address - Country:US
Mailing Address - Phone:307-235-9340
Mailing Address - Fax:307-237-2036
Practice Address - Street 1:475 S. SPRUCE ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1759
Practice Address - Country:US
Practice Address - Phone:307-235-9340
Practice Address - Fax:307-237-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 261QA0005X
WY251K00000X, 261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107031202Medicaid
WY1275674608Medicaid
WY107031203Medicaid
WYW302751Medicare PIN