Provider Demographics
NPI:1689207722
Name:SOUTH LINCOLN HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SOUTH LINCOLN HOSPITAL DISTRICT
Other - Org Name:ARROWHEAD FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/AO
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUNDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-877-4401
Mailing Address - Street 1:711 ONYX ST
Mailing Address - Street 2:
Mailing Address - City:KEMMERER
Mailing Address - State:WY
Mailing Address - Zip Code:83101-3214
Mailing Address - Country:US
Mailing Address - Phone:307-877-4401
Mailing Address - Fax:307-877-3236
Practice Address - Street 1:195 FEATHER WAY STOP 100
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9352
Practice Address - Country:US
Practice Address - Phone:307-200-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH LINCOLN HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-18
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty