Provider Demographics
NPI:1245282276
Name:COUNTY OF LINCOLN
Entity type:Organization
Organization Name:COUNTY OF LINCOLN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-885-9598
Mailing Address - Street 1:520 TOPAZ ST STE 109
Mailing Address - Street 2:
Mailing Address - City:KEMMERER
Mailing Address - State:WY
Mailing Address - Zip Code:83101-3131
Mailing Address - Country:US
Mailing Address - Phone:307-877-3780
Mailing Address - Fax:307-828-3114
Practice Address - Street 1:520 TOPAZ ST STE 109
Practice Address - Street 2:
Practice Address - City:KEMMERER
Practice Address - State:WY
Practice Address - Zip Code:83101-3131
Practice Address - Country:US
Practice Address - Phone:307-877-3780
Practice Address - Fax:307-828-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW308155Medicare ID - Type Unspecified