Organization Active NPI

Community Hospital

  • Rural Health Clinic/Center
  • Torrington, WY
National Provider Identifier
1174059786
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMMUNITY HOSPITAL
Practice address
625 Albany Ave
Torrington, WY 82240-1530
Phone
(307) 532-2107
NPI assigned
May 3, 2017
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Authorized official

Name
Zachary Miller
Title
Ceo
Phone
(307) 534-7054

Specialties & licenses 1

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

Addresses

Primary practice location

625 Albany Ave
Torrington, WY 82240-1530

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702

Other names 1

  • Banner Medical Clinic Torrington Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170608000298 WY Part A Provider - Rural Health Clinic 6608784194 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Torrington, WY

Rural health clinic certification: CCN 533993

Legal name
COMMUNITY HOSPITAL
Doing business as
BANNER MEDICAL CLINIC TORRINGTON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 13, 2017
Last certification
Jul 2, 2021
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
625 Albany Ave
Torrington, WY 82240-1530
Related CCNs
531307

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
M E Lee MD

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Julie Ann Alvarado-Dubek Individual Corporate OfficerOfficer Feb 1, 2022
Ingrid Long Individual Corporate DirectorCeo Jul 21, 2024
W-2 Managing Employee Jul 21, 2024
Marjorie J Bessel Individual Corporate OfficerOfficer Jan 1, 2018
Jean Lance Individual Corporate OfficerClo Apr 21, 2022
Staci Dickerson Individual Corporate OfficerCfo Jul 17, 2023
Carole Faig Individual Corporate DirectorBoard Member Mar 1, 2026
Paris Labruzzo Individual Corporate DirectorSr Director Feb 1, 2026
W-2 Managing Employee Feb 1, 2026
Dean M Harrison Individual Corporate DirectorBoard Member Sep 1, 2023
Anne Mariucci Individual Corporate DirectorBoard Member Mar 1, 2015
Sujata Gosalia Individual Corporate DirectorDirector Sep 1, 2018
Brenda a Schaefer Individual Corporate OfficerTreasurer Mar 6, 2014
Quentin P Smith Individual Corporate DirectorBoard Member Sep 1, 1999
Vicki Keiser Individual Corporate DirectorDirector Jun 1, 2017
Holly Gregory Individual Corporate DirectorSr Manager Feb 1, 2026
W-2 Managing Employee Feb 1, 2026
Sara Ward Individual Corporate DirectorBoard Member Sep 1, 2023
Michael L Butler Individual Corporate DirectorBoard Member Sep 1, 2025
Mary Schubert Individual Corporate OfficerAssistant Secretary Jan 1, 2024
Amy Perry Individual Corporate OfficerOfficer Nov 1, 2021
Rick Myers Individual Corporate DirectorDirector Sep 1, 2023
John F Koster Individual Corporate DirectorBoard Member Dec 11, 2015
Mark Wallace Individual Corporate DirectorDirector Sep 1, 2021
Christopher H Volk Individual Corporate DirectorBoard Member Dec 9, 2009
Michael Garnreiter Individual Corporate DirectorBoard Member Aug 1, 2012
Banner Health Organization, Phoenix, AZ Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 1, 2017 100%
Operational/Managerial Control May 1, 2017 100%

Owners & managing parties with NPI records 12

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 70

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

View all 70

NPI Registry JSON

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1174059786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 ALBANY AVE",
            "city": "TORRINGTON",
            "state": "WY",
            "postal_code": "822401530",
            "telephone_number": "307-532-2107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2017-05-03",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-534-7054"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Banner Medical Clinic Torrington",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Torrington, WY

Sources for this page

Verify at the official NPI Registry.