NPIMap

Organization Active NPI

Sublette County Hospital District

Doing business as Pinedale Medical Clinic

  • Family Medicine Physician
  • Pinedale, WY
National Provider Identifier
1104410596
Registry record updated Jul 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SUBLETTE COUNTY HOSPITAL DISTRICT
Doing business as
Pinedale Medical Clinic
Practice address
625 E Hennick St
Pinedale, WY 82941-5228
Phone
(307) 367-4133
Fax
(307) 459-8576
NPI assigned
Feb 25, 2021
Last updated
Jul 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2026

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

Authorized official

Name
Rex Walk
Title
Chief Executive Officer
Phone
(307) 367-0150

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

625 E Hennick St
Pinedale, WY 82941-5228

Mailing address

PO Box 627
Pinedale, WY 82941-0627
Phone (307) 367-4133

Other names 1

  • Pinedale Medical Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.sublettehospitaldistrict.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210518002474 WY Part B Supplier - Clinic/Group Practice 5496163461 Receives reassigned benefits from 13 practitioners
3 other NPIs on this enrollment
Practice locations: Big Piney, WY; Pinedale, WY

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Sublette County HealthPinedale, WY, CCN 531320 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Heritage HomePinedale, WY, CCN 535017 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jul 1, 2021
Jan 1, 2024
Jan 1, 2024

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1614211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783987200000",
    "number": "1104410596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 627",
            "city": "PINEDALE",
            "state": "WY",
            "postal_code": "829410627",
            "telephone_number": "307-367-4133",
            "fax_number": "307-459-8576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E HENNICK ST",
            "city": "PINEDALE",
            "state": "WY",
            "postal_code": "829415228",
            "telephone_number": "307-367-4133",
            "fax_number": "307-459-8576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBLETTE COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-25",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A",
        "authorized_official_last_name": "WALK",
        "authorized_official_first_name": "REX",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "307-367-0150"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.sublettehospitaldistrict.org",
            "affiliation": "N",
            "address_1": "625 E Hennick St",
            "city": "Pinedale",
            "state": "WY",
            "country_code": "US",
            "postal_code": "829415228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Pinedale Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pinedale Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pinedale, WY

Sources for this page

Verify at the official NPI Registry.