Provider Demographics
NPI:1922142777
Name:MEMORIAL HOSPITAL OF CARBON COUNTY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF CARBON COUNTY
Other - Org Name:WAGON CIRCLE ORTHOPEDIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
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 1:2012 W ELM STREET
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301
Mailing Address - Country:US
Mailing Address - Phone:307-324-6022
Mailing Address - Fax:307-324-3835
Practice Address - Street 1:2012 W ELM STREET
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301
Practice Address - Country:US
Practice Address - Phone:307-324-6022
Practice Address - Fax:307-324-3835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL OF CARBON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5186A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYZG9697OtherRR MEDICARE
WY05726001OtherBCBS
WY106366900Medicaid
WYZG9697OtherRR MEDICARE
WY106366900Medicaid
WY=========82301C002OtherTRIWEST