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Memorial Hospital of Converse County

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Douglas, WY

NPI 1285643221 · NPPES record last updated Feb 20, 2008

Key facts

NPI
1285643221
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
07163 (WY)
Legal business name
MEMORIAL HOSPITAL OF CONVERSE COUNTY
Practice address
111 S 5TH St
Douglas, WY 82633-2434
Phone
(307) 358-2122
Fax
(307) 358-9216
NPI assigned
Aug 7, 2006
Organization subpart
Yes
Parent organization (as reported)
MEMORIAL HOSPITAL OF CONVERSE COUNTY

Authorized official

Name
Mr. Curt Dugger
Title
Cfo
Phone
(307) 358-2122

Owners & managing parties with NPI records 4

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

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).

Corporate family (same tax ID) 4

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

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 77

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

View all 77

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WY

Hospital certification: CCN 53Z302

Legal name
MEMORIAL HOSPITAL OF CONVERSE COUNTY
Organization structure
Government · Non-profit
Enrollment address
111 S 5TH St
Douglas, WY 82633-2434
Hospital Swing-Bed Unit

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Memorial Hospital of Converse County
Organization · Douglas, WY 		5% Or Greater Indirect Ownership Interest Jan 1, 2014 100%
James Cussins
Individual 		W-2 Managing Employee
Cfo		 Jan 1, 2019 100%
Matthew M Dammeyer
Individual 		Corporate Director
Ceo		 Nov 1, 2019 100%

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Memorial Hospital of Converse County
Douglas, WY · CCN 531302		 Hospital 5% Or Greater Direct Ownership Interest (100%) Dec 31, 2009
Register Cliff Rural Health Clinic
Guernsey, WY · CCN 533989		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2004
Oregon Trail Rural Health Clinic
Rolling Hills, WY · CCN 533987		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1990

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070827000333 WY Part a Provider - Critical Access Hospital 2264340843 Practice locations: Douglas, WY

National Provider Directory

Tax ID family
Mem Hosp of Converse Cty (5 organizations share this tax ID)
Part of
Mem Hosp of Converse Cty

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 07163 WY Yes

Addresses

Primary practice location

111 S 5TH St
Douglas, WY 82633-2434

Mailing address

111 S 5TH St
P.O. Box 1450
Douglas, WY 82633-2434
Phone (307) 358-2122

Other providers in Douglas, WY

All providers in Douglas, WY · Medicare Defined Swing Bed Hospital Unit in Wyoming

Sources for this page

Verify at the official NPI Registry.