NPIMap

Organization Active NPI

South Lincoln Hospital District

Doing business as South Lincoln Medical Clinic Rock Springs

  • Clinic/Center
  • Rock Springs, WY
National Provider Identifier
1649803271
Registry record updated Jul 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SOUTH LINCOLN HOSPITAL DISTRICT
Doing business as
South Lincoln Medical Clinic Rock Springs
Practice address
2624 Commercial Way
Rock Springs, WY 82901-4769
Phone
(307) 522-5500
Fax
(307) 522-5559
NPI assigned
Feb 21, 2020
Last updated
Jul 13, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH LINCOLN HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 13, 2020

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

Authorized official

Name
Karl E Sundberg
Title
Ceo
Phone
(307) 877-4401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

2624 Commercial Way
Rock Springs, WY 82901-4769

Mailing address

711 Onyx St
Kemmerer, WY 83101-3214
Phone (307) 877-4401

Other names 1

  • SOUTH LINCOLN MEDICAL CLINIC ROCK SPRINGS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040604000832 WY Part B Supplier - Clinic/Group Practice 2961490057 Receives reassigned benefits from 22 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kemmerer, WY; Rock Springs, WY; Evanston, WY

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
South Lincoln Hospital Dist11 organizations share this tax ID, including this one
Part of
South Lincoln Hospital Dist

Other organizations with this tax ID 10

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

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1582243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594598400000",
    "number": "1649803271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 ONYX ST",
            "city": "KEMMERER",
            "state": "WY",
            "postal_code": "831013214",
            "telephone_number": "307-877-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2624 COMMERCIAL WAY",
            "city": "ROCK SPRINGS",
            "state": "WY",
            "postal_code": "829014769",
            "telephone_number": "307-522-5500",
            "fax_number": "307-522-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LINCOLN HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH LINCOLN HOSPITAL DISTRICT",
        "enumeration_date": "2020-02-21",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A",
        "authorized_official_last_name": "SUNDBERG",
        "authorized_official_first_name": "KARL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-877-4401"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH LINCOLN MEDICAL CLINIC ROCK SPRINGS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTH LINCOLN MEDICAL CLINIC ROCK SPRINGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rock Springs, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.