Memorial Hospital of Converse County
Organization Active NPI General Practice Physician · Douglas, WY
NPI 1356496491 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1356496491
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- 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
- Jan 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Curt Dugger
- Title
- Cfo
- Phone
- (307) 358-2122
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 4
Member of 1
Practitioners 269
-
David Barahal, M.D.
-
Allison Barnett, PA-C
-
Warren A Birch, MD
-
Mark Steven Campbell, M.D.
-
Richard Carver, CRNA
-
Amanda Kay Dykes, FNP-BC
-
Kerry Fischer, NP
-
Cesar Garcia, PA-C
-
Jonathan L Grosdidier, M.D.
-
Regg A Hagge, MD
-
Toni Marie Harms, FNP-C
-
Julie Lynn Johnson, APRN
-
Peggy Deane Johnson, FNP-C
-
Jennifer E. Keller, APRN
-
Janae Kinikin, RDN
-
Ashley M Littleton, RD, CDE
-
Terri Ann Joy Marso, PA-C
-
Karli McMillan, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (22 enrollments) in WY, KS, PA, FL, TX, VA, WI, MA, WA, ID, NV, OR, UT, OH, MI, CA, HI, CO, GA, SC
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Memorial Hospital of Converse County |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Dec 31, 2009 |
| Memorial Hospital of Converse County |
Hospital | 5% Or Greater Indirect Ownership Interest (100%) | Jan 1, 2014 |
| Register Cliff Rural Health Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2004 |
| Oregon Trail Rural Health Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1990 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031203000672 | WY | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 149 practitioners Practice locations: Moorcroft, WY; Newcastle, WY; Rawlins, WY; Riverton, WY; Torrington, WY; Wheatland, WY; Lusk, WY; Douglas, WY… |
| O20100206000094 | KS | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 2 practitioners Practice locations: Hays, KS; Topeka, KS; Wichita, KS |
| O20100208000322 | PA | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 1 practitioner Practice locations: Venetia, PA |
| O20100219000137 | FL | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 4 practitioners Practice locations: North Miami Beach, FL; Sarasota, FL; Santa Rosa Beach, FL; Palm City, FL; Melbourne Beach, FL |
| O20100607000600 | TX | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 3 practitioners Practice locations: Houston, TX; Spicewood, TX; Vidor, TX |
| O20100616000145 | VA | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 1 practitioner Practice locations: Glen Allen, VA |
| O20200423002857 | WY | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 2264340843 | Practice locations: Casper, WY |
| O20201111001825 | WY | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 2264340843 | Practice locations: Casper, WY |
| O20241226002640 | WI | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 1 practitioner Practice locations: Beloit, WI |
| O20241227001339 | MA | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 2 practitioners Practice locations: Lexington, MA; Boxford, MA |
| O20241227001483 | WA | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 2 practitioners Practice locations: Bellevue, WA; Liberty Lake, WA |
| O20241227001578 | ID | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 1 practitioner Practice locations: Coeur D Alene, ID; Worley, ID |
| O20241227001676 | NV | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 1 practitioner Practice locations: Reno, NV |
| O20241231000057 | OR | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 1 practitioner Practice locations: La Grande, OR |
| O20241231000184 | UT | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 2 practitioners Practice locations: Sandy, UT; Washington, UT |
| O20250102001822 | OH | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 1 practitioner Practice locations: Westlake, OH |
| O20250106000639 | MI | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 1 practitioner Practice locations: West Bloomfield, MI |
| O20250123001452 | CA | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 4 practitioners Practice locations: Huntington Beach, CA; San Diego, CA; Woodland Hills, CA |
| O20250123001860 | HI | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 1 practitioner Practice locations: Honolulu, HI |
| O20250207001302 | CO | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 5 practitioners Practice locations: Colorado Springs, CO; Denver, CO; Grand Junction, CO; Parker, CO |
| O20250210002252 | GA | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 3 practitioners Practice locations: Augusta, GA; Clayton, GA; Macon, GA |
| O20250218001221 | SC | Part B Supplier - Clinic/Group Practice | 2264340843 |
Receives reassigned benefits from 1 practitioner Practice locations: Sullivans Island, SC |
National Provider Directory
Locations
3 Church St
Paterson, NJ 07505
5820 E 2nd St
Casper, WY 82609
Phone (307) 234-9037
111 S 5th St
Fl 4
Douglas, WY 82633
Phone (307) 358-6200
111 S 5th St
Ste 2
Douglas, WY 82633
Phone (307) 358-7365
111 S 5th St
Ste 5
Douglas, WY 82633
700 E Center St
Douglas, WY 82633
Phone (307) 352-8946
1401 W 4th St
Gillette, WY 82716
Phone (307) 359-3562
2221 Elm St
Fl 2
Rawlins, WY 82301
Phone (307) 324-8252
204 15th St
Wheatland, WY 82201
Phone (307) 322-3636
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | WY | Yes |
Addresses
Primary practice location
111 S 5TH St
Douglas, WY 82633-2434
Mailing address
PO Box 1450
Douglas, WY 82633-1450
Phone (307) 358-2122
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00946001 | Other | WY | BLUE CROSS WY PHYS GROUP |
Other providers in Douglas, WY
- Meghann Mara McAndrew
- Karli McMillan
- Jessica McWilliams
- Memorial Hospital of Converse County
- Memorial Hospital of Converse County
- Memorial Hospital of Converse County
- Mindful Connection Counseling
- Beverly Mix
- Bobbyjo Moberly
- Chelsea Hana Moore
All providers in Douglas, WY · General Practice Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.