Provider Demographics
NPI:1851319883
Name:COUNTY OF CARBON
Entity Type:Organization
Organization Name:COUNTY OF CARBON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:HETTGAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-328-2607
Mailing Address - Street 1:P.O. BOX 1013
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301
Mailing Address - Country:US
Mailing Address - Phone:307-328-2607
Mailing Address - Fax:307-328-2602
Practice Address - Street 1:215 BUFFALO ST.
Practice Address - Street 2:SUITE 139, CARBON BLDG.
Practice Address - City:RAWLLINS
Practice Address - State:WY
Practice Address - Zip Code:82301
Practice Address - Country:US
Practice Address - Phone:307-328-2607
Practice Address - Fax:307-328-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07-185251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107232300Medicaid
WYW20251Medicare PIN