Provider Demographics
NPI:1184740979
Name:CITY OF CASPER-NATRONA COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:CITY OF CASPER-NATRONA COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:PH, MPH
Authorized Official - Phone:307-235-9340
Mailing Address - Street 1:475 S. SPRUCE ST.
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1759
Mailing Address - Country:US
Mailing Address - Phone:307-235-9340
Mailing Address - Fax:307-237-2036
Practice Address - Street 1:475 S. SPRUCE ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1759
Practice Address - Country:US
Practice Address - Phone:307-235-9340
Practice Address - Fax:307-237-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251B00000X, 251K00000X
WY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107031200Medicaid
WY107031204Medicaid
WY107031216Medicaid