Provider Demographics
NPI:1851429815
Name:CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CAMPBELL COUNTY HOSPITAL DISTRICT
Other - Org Name:HOME MEDICAL RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-688-6260
Mailing Address - Street 1:901 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3404
Mailing Address - Country:US
Mailing Address - Phone:307-688-6260
Mailing Address - Fax:307-688-6265
Practice Address - Street 1:901 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3404
Practice Address - Country:US
Practice Address - Phone:307-688-6260
Practice Address - Fax:307-688-6265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMPBELL COUNTY HOSPTIAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY0691930003Medicare NSC