Provider Demographics
NPI:1457462087
Name:COUNTY OF FREMONT
Entity Type:Organization
Organization Name:COUNTY OF FREMONT
Other - Org Name:FREMONT COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEMPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-857-3669
Mailing Address - Street 1:1052 PETERSDORF DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2308
Mailing Address - Country:US
Mailing Address - Phone:307-857-3669
Mailing Address - Fax:307-857-3665
Practice Address - Street 1:1052 PETERSDORF DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2308
Practice Address - Country:US
Practice Address - Phone:307-857-3669
Practice Address - Fax:307-857-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1253416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107244700Medicaid
WY303868OtherBCBS OF WYOMING
MAZ31843OtherBCBS OF MASSACHUSETTS
185875300OtherUSDOL
185875300OtherUSDOL
WY303868OtherBCBS OF WYOMING
WY107244700Medicaid
=========OtherINDIAN HEALTH SERVICE-PHS
185875300OtherUSDOL
=========825010000OtherTRICARE
=========Medicare ID - Type UnspecifiedHUMANA GOLD HMO
0113263Medicare ID - Type UnspecifiedUMWA