Provider Demographics
NPI:1891006839
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:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-324-8347
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:307-324-2221
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:82301-5108
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:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10182275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107207202Medicaid
WY107207202Medicaid
WY53Z316Medicare Oscar/Certification