Provider Demographics
NPI:1467534081
Name:WEST PARK HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WEST PARK HOSPITAL DISTRICT
Other - Org Name:LONG TERM CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-578-2490
Mailing Address - Street 1:707 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3409
Mailing Address - Country:US
Mailing Address - Phone:307-527-7501
Mailing Address - Fax:307-578-2485
Practice Address - Street 1:707 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3409
Practice Address - Country:US
Practice Address - Phone:307-527-7501
Practice Address - Fax:307-578-2485
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST PARK HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY06-003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106133004Medicaid
WY007062OtherBLUE CROSS
WY106133005Medicaid
WY041793OtherBLUE CROSS
WY106133004Medicaid
WY041793OtherBLUE CROSS