Provider Demographics
NPI:1427595271
Name:EVANSTON HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:EVANSTON HOSPITAL CORPORATION
Other - Org Name:BRIDGER VALLEY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR PHYSICIAN REV CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3641
Mailing Address - Street 1:531 PARKWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:WY
Mailing Address - Zip Code:82939-0208
Mailing Address - Country:US
Mailing Address - Phone:307-782-7560
Mailing Address - Fax:307-782-7024
Practice Address - Street 1:531 PARKWAY DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:WY
Practice Address - Zip Code:82939-0208
Practice Address - Country:US
Practice Address - Phone:307-782-7560
Practice Address - Fax:307-782-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15107261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health