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
(307) 742-0678
Mailing address
255 N 30TH ST, LARAMIE, WY 82072-5140
(307) 742-2142
(307) 742-0678
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
07108
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00710001
BCBS PROFESSIONAL
WY
01
—
007153
BCBS - INSTITUTIONAL
WY
05
—
107332000
—
WY
05
—
107332001
—
WY
05
—
107332002
—
WY
05
—
107332003
—
WY
05
—
107332008
—
WY
01
—
836000188
CHAMPUS
WY
05
—
95682704
—
CO
01
—
W4251905
PTAN FOR PART B
WY
Enumeration date
02/07/2007
Last updated
12/27/2017
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