# WYOMING MEDICAL CENTER INC

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

## Provider details

- **NPI number:** 1356433957
- **Authorized official:** DENNIS LARAWAY BBA MPH (CFO)
- **Authorized official phone:** (602) 747-4000

## Contact information

- **Practice address:** 1233 E 2ND STREET, CASPER, WY 82601
- **Practice address phone:** (307) 577-7201
- **Practice address fax:** (307) 237-1703
- **Mailing address:** 2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 07131 | WY | Yes |

## Other

- **Enumeration date:** 09/29/2006
- **Last updated:** 01/26/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00701001 | BLUE SHIELD | — |
| 01 | — | 007047 | BLUE CROSS | — |
| 05 | — | 106898900 | — | WY |
| 01 | — | CC7579 | MEDICARE RR | WY |