Provider Demographics
NPI:1932404084
Name:CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CAMPBELL COUNTY HOSPITAL DISTRICT
Other - Org Name:CCMH UROLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:K
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-688-1000
Mailing Address - Street 1:PO BOX 392967
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9967
Mailing Address - Country:US
Mailing Address - Phone:307-688-3636
Mailing Address - Fax:
Practice Address - Street 1:501 S BURMA AVE - 3S-URO
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3426
Practice Address - Country:US
Practice Address - Phone:307-688-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMPBELL COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty