Evanston Hospital Corporation
Organization Active NPI Family Medicine Physician · Lyman, WY
NPI 1366989014 · NPPES record last updated Sep 20, 2018
Key facts
- NPI
- 1366989014
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- EVANSTON HOSPITAL CORPORATION
- Practice address
- 107 N Main St.
Lyman, WY 82937-0001 - Phone
- (307) 787-3313
- NPI assigned
- Jan 19, 2017
- Organization subpart
- No
Authorized official
- Name
- Jeremy Davis
- Title
- Ceo
- Phone
- (307) 783-8255
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 2
Practitioners 12
-
Richard Carver, CRNA
-
Melissa A Foster, FNP-C
-
Michael Hunt, CRNA, FNP, APRN
-
Brandon Allen Aven, CRNA
-
Klarissa N Beller, M.D.
-
Taylor Jay Christensen, M.D.
-
Maria A Cuda, D.O.
-
Scott S Felt, CRNA
-
Dorian S Grunig, CRNA
-
Sara Hunt, FNP-C
-
Lauri S Morgan, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040609001235 | WY | Part B Supplier - Clinic/Group Practice | 7113900358 |
Receives reassigned benefits from 27 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Evanston, WY; Lyman, WY |
National Provider Directory
- Tax ID family
- Evanston Hospital Corp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
107 N Main St.
Lyman, WY 82937-0001
Mailing address
PO Box 5009
Brentwood, TN 37024-5009
Phone (615) 221-1400
Other providers in Lyman, WY
- Zanna L Clifford Olguin
- Lynn J Clifford
- Cowboy Cares, Inc.
- Evanston Clinic Corp
- Evanston Hospital Corporation
- David Christopher Fields
- Felicia Renee Galvin
- Jessica Groll
- Bryce Habel
- Christopher D Harris
All providers in Lyman, WY · Family Medicine 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 Sep 20, 2018. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.