Provider Demographics
NPI:1699369082
Name:SUBLETTE COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SUBLETTE COUNTY HOSPITAL DISTRICT
Other - Org Name:MARBLETON-BIG PINEY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-276-3306
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-0787
Mailing Address - Country:US
Mailing Address - Phone:307-276-3306
Mailing Address - Fax:
Practice Address - Street 1:103 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BIG PINEY
Practice Address - State:WY
Practice Address - Zip Code:83113-5022
Practice Address - Country:US
Practice Address - Phone:307-276-3306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty