Provider Demographics
NPI:1730132523
Name:NORTH LINCOLN COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:NORTH LINCOLN COUNTY HOSPITAL DISTRICT
Other - Org Name:STAR VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REV CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-885-5877
Mailing Address - Street 1:901 ADAMS
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-9621
Mailing Address - Country:US
Mailing Address - Phone:307-885-5800
Mailing Address - Fax:307-885-5865
Practice Address - Street 1:901 ADAMS
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-9621
Practice Address - Country:US
Practice Address - Phone:307-885-5800
Practice Address - Fax:307-885-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY207Q00000X
WY10309275N00000X
WY09184341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No341600000XTransportation ServicesAmbulanceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114481204Medicaid
WYW308173Medicare PIN