Ivinson Memorial Hospital

Organization Active NPI Rural Health Clinic/Center · Laramie, WY

NPI 1033628599 · NPPES record last updated Dec 26, 2025

Key facts

NPI
1033628599
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 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
Organization subpart
Yes
Parent organization (as reported)
IVINSON MEMORIAL HOSPITAL

Authorized official

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

Owned or controlled facilities with NPI records 3

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

Other NPIs with the same Medicare PAC ID 4

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

Practitioners 176

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 176

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WY

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

Medicare enrollment records

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

National Provider Directory

Part of
Ivinson Memorial Hospital

Locations

255 N 30th St
Laramie, WY 82072
Phone (307) 742-2141

201 14th St
Ste B
Wheatland, WY 82201

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes
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

Other providers in Laramie, WY

All providers in Laramie, WY · Rural Health Clinic/Center in Wyoming

Sources for this page

Verify at the official NPI Registry.