City of Pine Bluffs

Primary specialty

AmbulanceTaxonomy code 341600000X

License

63 Issued in WY

Legal business name

CITY OF PINE BLUFFS

Practice address

220 Main Street
Pine Bluffs, WY 82082-0429

Phone

(307) 245-3746

NPI assigned

Jan 16, 2007

Organization subpart

No

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

Authorized official

Name

Shannon R Weller

Title

Director

Phone

(307) 245-3400

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Pine Bluffs-EMS Doing business as

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294704000000",
    "number": "1821149535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 641880",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681647880",
            "telephone_number": "402-572-4019",
            "fax_number": "402-965-8594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 MAIN STREET",
            "city": "PINE BLUFFS",
            "state": "WY",
            "postal_code": "820820429",
            "telephone_number": "307-245-3746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF PINE BLUFFS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2011-01-11",
        "status": "A",
        "authorized_official_last_name": "WELLER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "307-245-3400"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "WY",
            "license": "63",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "306502",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114308500",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Bluffs-EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lacey Adkins
• Advanced Respiratory Care
• Rene Baker
• Kelcey Bullock
• Terry Cash
• Megan C Dean
• Rebecca Hampton, BS
• High Country Healthwatch, LLC
• Kimball County Hospital
• Dale T. Lansden, D.D.S.

• All providers in Pine Bluffs, WY
• Ambulance in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; 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.