Provider Demographics
NPI:1437312436
Name:MEMORIAL HOSPITAL OF SWEETWATER COUNTY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF SWEETWATER COUNTY
Other - Org Name:COUNTY OF SWEETWATER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-352-8413
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1359
Mailing Address - Country:US
Mailing Address - Phone:307-352-8125
Mailing Address - Fax:307-352-8126
Practice Address - Street 1:1180 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901
Practice Address - Country:US
Practice Address - Phone:307-352-8125
Practice Address - Fax:307-352-8126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL OF SWEETWATER COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-09
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107352401Medicaid
WY3000222OtherBLUE CROSS
WYW300022Medicare PIN
WY107352401Medicaid