Provider Demographics
NPI:1417031311
Name:MEMORIAL HOSPITAL OF CARBON COUNTY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF CARBON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-324-8347
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-0460
Mailing Address - Country:US
Mailing Address - Phone:307-324-2221
Mailing Address - Fax:307-324-8368
Practice Address - Street 1:2221 W ELM ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301
Practice Address - Country:US
Practice Address - Phone:307-324-2221
Practice Address - Fax:307-324-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY08-187275N00000X
WY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107207203Medicaid
WY107207206Medicaid
WY107207202Medicaid
WY107207204Medicaid
WY107207200Medicaid
WY107207201Medicaid
WY107207209Medicaid
WY007211OtherBLUE CROSS BLUE SHEILD UB
WY00738001OtherBLX BLS 1500
WY107207209Medicaid
WY=========OtherWORKERS COMP
WY107207202Medicaid
WY107207200Medicaid
WY107207203Medicaid
WY007211OtherBLUE CROSS BLUE SHEILD UB
WY=========OtherWORKERS COMP
WY107207204Medicaid