Provider Demographics
NPI:1295858744
Name:JOHNSON COUNTY
Entity Type:Organization
Organization Name:JOHNSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-684-2564
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-0100
Mailing Address - Country:US
Mailing Address - Phone:307-684-2564
Mailing Address - Fax:307-684-0744
Practice Address - Street 1:85 KLONDIKE DRIVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1624
Practice Address - Country:US
Practice Address - Phone:307-684-2564
Practice Address - Fax:307-684-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107260900Medicaid
WYW306517Medicare PIN