Organization
IVINSON MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES BANDS (CFO)
(307) 755-4603
Entity
Organization
Contact information
Practice address
255 N 30TH ST, LARAMIE, WY 82072-5140
(307) 742-2142
Mailing address
255 N 30TH ST, LARAMIE, WY 82072-5140
(307) 742-2142
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W4251905
PTAN FOR PART B
—
Enumeration date
12/03/2010
Last updated
12/27/2017
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