Provider Demographics
NPI:1609318526
Name:CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CAMPBELL COUNTY HOSPITAL DISTRICT
Other - Org Name:CAMPBELL COUNTY MEDICAL GROUP - ANTICOAGULATION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-688-1523
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3046
Mailing Address - Country:US
Mailing Address - Phone:307-688-2600
Mailing Address - Fax:307-685-3079
Practice Address - Street 1:501 S BURMA AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3426
Practice Address - Country:US
Practice Address - Phone:307-688-3636
Practice Address - Fax:307-688-7920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13357163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty