Provider Demographics
NPI:1508817339
Name:SUBLETTE COUNTY RURAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:SUBLETTE COUNTY RURAL HEALTH CARE DISTRICT
Other - Org Name:SUBLETTE COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GATZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-276-4451
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-0627
Mailing Address - Country:US
Mailing Address - Phone:307-276-4451
Mailing Address - Fax:307-276-4447
Practice Address - Street 1:635 E HENNICK
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941
Practice Address - Country:US
Practice Address - Phone:307-367-2315
Practice Address - Fax:307-276-4447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUBLETTE COUNTY RURAL HEALTH CARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106950100Medicaid
WYW306750Medicare PIN