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Campbell County Hospital District

Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Gillette, WY

NPI 1144313255 · NPPES record last updated Nov 20, 2017

Key facts

NPI
1144313255
Entity type
Organization (NPI type 2)
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
License
06-210 (WY)
Legal business name
CAMPBELL COUNTY HOSPITAL DISTRICT
Practice address
501 S Burma Ave
Gillette, WY 82716-3426
Phone
(307) 688-1415
Fax
(307) 688-1420
NPI assigned
Oct 2, 2006
Organization subpart
No

Authorized official

Name
Dalton Huber
Title
Cfo
Phone
(307) 688-1523

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 34

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

View all 34

Practitioners 128

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

View all 128

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WY

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
The Hospice of Campbell County Memorial Hospital
Gillette, WY · CCN 531519		 Hospice 5% Or Greater Direct Ownership Interest (100%) Jul 25, 2003

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070926000304 WY Part a Provider - End-Stage Renal Disease Facility (ESRD) 2860392529 Practice locations: Gillette, WY

National Provider Directory

Tax ID family
Community Mental Health Services (35 organizations share this tax ID)

Locations

501 S Burma Ave
Gillette, WY 82716
Phone (307) 682-8811

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 06-210 WY Yes

Addresses

Primary practice location

501 S Burma Ave
Gillette, WY 82716-3426

Mailing address

501 S Burma Ave
Gillette, WY 82716-3426
Phone (307) 688-1415

Other providers in Gillette, WY

All providers in Gillette, WY · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wyoming

Sources for this page

Verify at the official NPI Registry.