Provider Demographics
NPI:1558361949
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:
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 2:1200 COLLEGE DRIVE
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1359
Mailing Address - Country:US
Mailing Address - Phone:307-362-3711
Mailing Address - Fax:307-352-8155
Practice Address - Street 1:1200 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:307-362-3711
Practice Address - Fax:307-352-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY06-195282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107352400Medicaid
WY1558361949OtherNPI
532304Medicare PIN
WY530011Medicare Oscar/Certification
530011Medicare PIN
WY107352400Medicaid
WY532304Medicare Oscar/Certification