Provider Demographics
NPI:1427091347
Name:NIOBRARA COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:NIOBRARA COUNTY HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:DOUCETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-334-4000
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:LUSK
Mailing Address - State:WY
Mailing Address - Zip Code:82225-0780
Mailing Address - Country:US
Mailing Address - Phone:307-334-4000
Mailing Address - Fax:307-334-0183
Practice Address - Street 1:921 S BALLANCEE AVENUE
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225
Practice Address - Country:US
Practice Address - Phone:307-334-4000
Practice Address - Fax:307-334-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY06-203282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY41778OtherBLUE CROSS BLUE SHIELD
WY1217348Medicaid
WY531314Medicare ID - Type Unspecified
WY53Z314Medicare Oscar/Certification
WY533986Medicare Oscar/Certification