Provider Demographics
NPI:1750485793
Name:NORTH BIG HORN HOSPITAL
Entity Type:Organization
Organization Name:NORTH BIG HORN HOSPITAL
Other - Org Name:NORTH BIG HORN HOSPITAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-548-5203
Mailing Address - Street 1:1115 LANE 12
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-9537
Mailing Address - Country:US
Mailing Address - Phone:307-548-5201
Mailing Address - Fax:307-548-5224
Practice Address - Street 1:1115 LANE 12
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-9537
Practice Address - Country:US
Practice Address - Phone:307-548-5201
Practice Address - Fax:307-548-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07-128261QR1300X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
D8557OtherMEDICARE RAILROAD
WY107370204Medicaid
WY107370204Medicaid
WY533984Medicare Oscar/Certification
0448430001Medicare NSC