Organization
EVANSTON HOSPITAL CORPORATION
Active
Other names
Evanston Regional Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY MICHAEL COOPER (SVP FINANCE OP/AUTHORIZED OFFICIAL)
(615) 221-3840
Entity
Organization
Contact information
Practice address
190 ARROWHEAD DR, EVANSTON, WY 82930-9266
(307) 789-3636
(307) 783-8167
Mailing address
PO BOX 6000 FILE 73783, SAN FRANCISCO, CA 94160-0001
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
06-165
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11458
IHC
—
05
—
114835400
—
WY
01
—
310161600
DEPT OF LABOR
—
01
—
41376
BCBS
—
Enumeration date
02/01/2006
Last updated
08/11/2020
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