Organization
EVANSTON HOSPITAL CORPORATION
Active
Parent organization
EVANSTON HOSPITAL CORPORATION
Other names
Evanston Dialysis Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVANSTON HOSPITAL CORPORATION
Authorized official
RANDY MICHAEL COOPER (SVP FINANCE OPERATIONS/AO)
(615) 221-3840
Entity
Organization
Contact information
Practice address
112 YELLOW CREEK RD, EVANSTON, WY 82930-9266
(307) 789-3636
Mailing address
190 ARROWHEAD DR, EVANSTON, WY 82930-9266
(307) 789-3636
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
06-102
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114835407
—
WY
Enumeration date
02/10/2006
Last updated
09/03/2020
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