# WYOMING STATE HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104811256
- **Authorized official:** MR. PABLO HERNANDEZ M.D (SUPERINTENDENT)
- **Authorized official phone:** (307) 789-3464

## Contact information

- **Practice address:** 831 HIGHWAY 150 S, PHARMACY RM 519, EVANSTON, WY 82930-5340
- **Practice address phone:** (307) 789-3464
- **Practice address fax:** (307) 789-3660
- **Mailing address:** 831 HIGHWAY 150 S, PO BOX 177, EVANSTON, WY 82930-5340
- **Mailing address phone:** (307) 789-3464
- **Mailing address fax:** (307) 789-3660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 281P00000X | Chronic Disease Hospital | 52-01138 | WY | Yes |

## Other

- **Enumeration date:** 09/14/2005
- **Last updated:** 08/22/2020