Organization
WYOMING STATE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PABLO HERNANDEZ M.D (SUPERINTENDENT)
(307) 789-3464
Entity
Organization
Contact information
Practice address
831 HIGHWAY 150 S, PHARMACY RM 519, EVANSTON, WY 82930-5340
(307) 789-3464
(307) 789-3660
Mailing address
831 HIGHWAY 150 S, PO BOX 177, EVANSTON, WY 82930-5340
(307) 789-3464
(307) 789-3660
Taxonomy
Speciality
Code
Description
License number
State
281P00000X
Chronic Disease Hospital
Primary
52-01138
WY
Other
Enumeration date
09/14/2005
Last updated
08/22/2020
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