Provider Demographics
NPI:1194869115
Name:MEMORIAL HOSPITAL OF CARBON COUNTY
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL OF CARBON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:HANNA
Mailing Address - State:WY
Mailing Address - Zip Code:82327-0689
Mailing Address - Country:US
Mailing Address - Phone:307-325-6596
Mailing Address - Fax:307-325-6597
Practice Address - Street 1:1008 FELDSPAR COURT
Practice Address - Street 2:
Practice Address - City:HANNA
Practice Address - State:WY
Practice Address - Zip Code:82327
Practice Address - Country:US
Practice Address - Phone:307-325-6596
Practice Address - Fax:307-325-6597
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
WY2916A261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107205600Medicaid
WY1399310OtherUMWA
WY00863001OtherBCBS OF WYOMING
WY185872500OtherFEDERAL WORKERS COMP
WY1399310OtherUMWA
WY=========82327A001OtherTRIWEST
WY=========82327A001OtherTRIWEST
WYCC7577Medicare ID - Type UnspecifiedRR MEDICARE GROUP