NPIMap

Organization Active NPI

Wyoming State Hospital

  • Chronic Disease Hospital
  • Evanston, WY
National Provider Identifier
1104811256
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Chronic Disease HospitalTaxonomy code 281P00000X
License
52-01138 Issued in WY
Legal business name
WYOMING STATE HOSPITAL
Practice address
831 Highway 150 S
Pharmacy RM 519
Evanston, WY 82930-5340
Phone
(307) 789-3464
Fax
(307) 789-3660
NPI assigned
Sep 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Pablo Hernandez, M.D
Title
Superintendent
Phone
(307) 789-3464

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chronic Disease Hospital 281P00000X 52-01138 WY Primary

Addresses

Primary practice location

831 Highway 150 S
Pharmacy RM 519
Evanston, WY 82930-5340

Mailing address

831 Highway 150 S
PO Box 177
Evanston, WY 82930-5340
Phone (307) 789-3464

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
53D0679889Wyoming State Hospital Laboratory831 Highway 150 South #733B, Evanston, WY 82930ComplianceApr 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Division of Health Care11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

831 Highway 150 S
Rm 519
Evanston, WY 82930
Phone (307) 789-3464

NPI Registry JSON

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104811256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 HIGHWAY 150 S",
            "address_2": "PO BOX 177",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305340",
            "telephone_number": "307-789-3464",
            "fax_number": "307-789-3660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 HIGHWAY 150 S",
            "address_2": "PHARMACY RM 519",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305340",
            "telephone_number": "307-789-3464",
            "fax_number": "307-789-3660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYOMING STATE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "PABLO",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "307-789-3464",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "281P00000X",
            "taxonomy_group": "",
            "desc": "Chronic Disease Hospital",
            "state": "WY",
            "license": "52-01138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.