# SOUTH LINCOLN HOSPITAL DISTRICT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Lincoln Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700910411
- **Authorized official:** MR. ERIC H BOLEY (CEO)
- **Authorized official phone:** (307) 877-4401

## Contact information

- **Practice address:** 711 ONYX ST, KEMMERER, WY 83101-3214
- **Practice address phone:** (307) 877-4401
- **Practice address fax:** (307) 877-3236
- **Mailing address:** 711 ONYX ST, KEMMERER, WY 83101-3214
- **Mailing address phone:** (307) 877-4401
- **Mailing address fax:** (307) 877-3236

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | 52-03675-IP | WY | Yes |
| 3336L0003X | Long Term Care Pharmacy | 52-03675 | WY | — |

## Other

- **Enumeration date:** 03/15/2007
- **Last updated:** 01/05/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 105993909 | — | WY |