Provider Demographics
NPI:1275810160
Name:COMMUNITY HEALTH CENTER OF CENTRAL WYOMING INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF CENTRAL WYOMING INC
Other - Org Name:COMMUNITY HEALTH CENTER OF CENTRAL WYOMING INC RIVERTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-233-6000
Mailing Address - Street 1:5000 BLACKMORE RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3345
Mailing Address - Country:US
Mailing Address - Phone:307-233-6000
Mailing Address - Fax:307-233-6089
Practice Address - Street 1:1035 ROSE LANE
Practice Address - Street 2:SUITE 2
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2291
Practice Address - Country:US
Practice Address - Phone:307-463-7160
Practice Address - Fax:307-463-7159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTER OF CENTRAL WYOMING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-07
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)