Provider Demographics
NPI:1336289297
Name:VASE FUNERAL HOME
Entity Type:Organization
Organization Name:VASE FUNERAL HOME
Other - Org Name:VASE EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:VASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-362-5607
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-2400
Mailing Address - Country:US
Mailing Address - Phone:866-883-4336
Mailing Address - Fax:307-362-4339
Practice Address - Street 1:168 ELK ST
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5241
Practice Address - Country:US
Practice Address - Phone:307-362-5607
Practice Address - Fax:307-362-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY683416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112443900Medicaid
WY04796001OtherBLUE CROSS BLUE SHIELD
WY04796001OtherBLUE CROSS BLUE SHIELD