Provider Demographics
NPI:1285854174
Name:GLENROCK HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GLENROCK HOSPITAL DISTRICT
Other - Org Name:GLENROCK HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-436-9206
Mailing Address - Street 1:925 W BIRCH ST
Mailing Address - Street 2:PO BOX 786
Mailing Address - City:GLENROCK
Mailing Address - State:WY
Mailing Address - Zip Code:82637-0786
Mailing Address - Country:US
Mailing Address - Phone:307-436-9206
Mailing Address - Fax:307-436-9730
Practice Address - Street 1:925 W BIRCH ST
Practice Address - Street 2:
Practice Address - City:GLENROCK
Practice Address - State:WY
Practice Address - Zip Code:82637-0786
Practice Address - Country:US
Practice Address - Phone:307-436-9206
Practice Address - Fax:307-436-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW306925Medicare ID - Type UnspecifiedRADIOLOGY