Provider Demographics
NPI:1285657007
Name:NORTH LINCOLN COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:NORTH LINCOLN COUNTY HOSPITAL DISTRICT
Other - Org Name:STAR VALLEY MEDICAL CENTER EMTS
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-885-5811
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0579
Mailing Address - Country:US
Mailing Address - Phone:307-885-5800
Mailing Address - Fax:307-885-5865
Practice Address - Street 1:901 ADAMS
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-0579
Practice Address - Country:US
Practice Address - Phone:307-885-5800
Practice Address - Fax:307-885-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY01341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1285657007OtherMEDICARE
WY1285657007Medicaid
WY1255376406Medicaid