Provider Demographics
NPI:1407341308
Name:HIGH DESERT RURAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:HIGH DESERT RURAL HEALTH CARE DISTRICT
Other - Org Name:WAMSUTTER COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT -BOARD OF TRUSTEES
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:STAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-324-9534
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:WAMSUTTER
Mailing Address - State:WY
Mailing Address - Zip Code:82336-0338
Mailing Address - Country:US
Mailing Address - Phone:307-324-8869
Mailing Address - Fax:307-324-8969
Practice Address - Street 1:401 FULTZ DRIVE
Practice Address - Street 2:
Practice Address - City:WAMSUTTER
Practice Address - State:WY
Practice Address - Zip Code:82336-0338
Practice Address - Country:US
Practice Address - Phone:307-324-8869
Practice Address - Fax:307-324-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty