Organization
WYOMING MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1233 E 2ND STREET, CASPER, WY 82601
(307) 577-7201
(307) 237-1703
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
07148
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00701001
BLUE SHIELD
—
01
—
007047
BLUE CROSS
—
05
—
106898900
—
WY
01
—
CC7579
MEDICARE RR
WY
Enumeration date
09/29/2006
Last updated
01/26/2022
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