NPIMap

Organization Active NPI

Ivinson Memorial Hospital

  • Rural Health Clinic/Center
  • Laramie, WY
National Provider Identifier
1033628599
Registry record updated Dec 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
IVINSON MEMORIAL HOSPITAL
Practice address
3116 Willett Dr
Laramie, WY 82072-5048
Phone
(307) 742-6319
Fax
(307) 742-6346
NPI assigned
Sep 27, 2017
Last updated
Dec 26, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
IVINSON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Bands
Title
Cfo
Phone
(307) 755-4603

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

3116 Willett Dr
Laramie, WY 82072-5048

Mailing address

255 N 30TH St
Laramie, WY 82072-5140
Phone (307) 742-2142

Other practice location 1

255 N 30th St
Laramie, WY 82072-5140
Phone (307) 742-2142

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171213002021 WY Part B Supplier - Clinic/Group Practice 8325304447 Receives reassigned benefits from 167 practitioners
Practice locations: Laramie, WY

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Ivinson Memorial Hospital

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ivinson Memorial HospitalLaramie, WY, CCN 530025 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018
Ivinson Memorial HospitalLaramie, WY, CCN 53S025 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018
Ivinson Memorial HospitalLaramie, WY, CCN 53U025 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 175

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 175

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766707200000",
    "number": "1033628599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 N 30TH ST",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820725140",
            "telephone_number": "307-742-2142",
            "fax_number": "307-742-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3116 WILLETT DR",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820725048",
            "telephone_number": "307-742-6319",
            "fax_number": "307-742-6346"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 N 30th St",
            "address_purpose": "LOCATION",
            "city": "Laramie",
            "state": "WY",
            "postal_code": "820725140",
            "country_code": "US",
            "telephone_number": "307-742-2142",
            "fax_number": "307-742-2150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IVINSON MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IVINSON MEMORIAL HOSPITAL",
        "enumeration_date": "2017-09-27",
        "last_updated": "2025-12-26",
        "certification_date": "2025-12-26",
        "status": "A",
        "authorized_official_last_name": "BANDS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "307-755-4603"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laramie, WY

Sources for this page

Verify at the official NPI Registry.