Provider Demographics
NPI:1609827435
Name:SUBLETTE COUNTY RURAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:SUBLETTE COUNTY RURAL HEALTH CARE DISTRICT
Other - Org Name:MARBLETON-BIG PINEY CLINIC
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 787
Mailing Address - Street 2:
Mailing Address - City:BIG PINEY
Mailing Address - State:WY
Mailing Address - Zip Code:83113-0787
Mailing Address - Country:US
Mailing Address - Phone:307-276-4451
Mailing Address - Fax:307-276-4447
Practice Address - Street 1:103 W 3RD STREET
Practice Address - Street 2:
Practice Address - City:MARBLETON
Practice Address - State:WY
Practice Address - Zip Code:83113
Practice Address - Country:US
Practice Address - Phone:307-276-3306
Practice Address - Fax:307-276-3024
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:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121421700Medicaid
WY20339Medicare PIN
WYW20339Medicare PIN