Provider Demographics
NPI:1881748978
Name:COUNTY OF PARK
Entity type:Organization
Organization Name:COUNTY OF PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-527-8570
Mailing Address - Street 1:1002 SHERIDAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3532
Mailing Address - Country:US
Mailing Address - Phone:307-527-8570
Mailing Address - Fax:307-527-8575
Practice Address - Street 1:1002 SHERIDAN AVENUE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3532
Practice Address - Country:US
Practice Address - Phone:307-527-8570
Practice Address - Fax:307-527-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07-116251B00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107279001Medicaid
WY107279000Medicaid
WY107279000Medicaid