Organization
SOUTH LINCOLN HOSPITAL DISTRICT
Active
Other names
South Lincoln Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC H BOLEY (CEO)
(307) 877-4401
Entity
Organization
Contact information
Practice address
711 ONYX ST, KEMMERER, WY 83101-3214
(307) 877-4401
(307) 877-3236
Mailing address
711 ONYX ST, KEMMERER, WY 83101-3214
(307) 877-4401
(307) 877-3236
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
52-03675-IP
WY
3336L0003X
Long Term Care Pharmacy
52-03675
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105993909
—
WY
Enumeration date
03/15/2007
Last updated
01/05/2012
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