Provider Demographics
NPI:1710298757
Name:MEMORIAL HOSPITAL OF CARBON COUNTY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF CARBON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-324-2221
Mailing Address - Street 1:2221 ELM ST
Mailing Address - Street 2:P.O. BOX 460
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5108
Mailing Address - Country:US
Mailing Address - Phone:307-324-8221
Mailing Address - Fax:307-324-8232
Practice Address - Street 1:2221 ELM ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-0460
Practice Address - Country:US
Practice Address - Phone:307-324-8221
Practice Address - Fax:307-324-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW4252409OtherMEDICARE PART B PTAN
WYCP0162OtherRAILROAD MEDICARE
WY107207200Medicaid
WYW4252409OtherMEDICARE PART B PTAN
WY107207200Medicaid