Organization
SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
Active
Parent organization
SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
Other names
Midway Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
Authorized official
MR. JOEL JACKSON (CHIEF EXECUTIVE OFFICER)
(307) 568-1426
Entity
Organization
Contact information
Practice address
388 SOUTH US HWY 20, BASIN, WY 82410-8902
(307) 568-3311
(307) 568-2139
Mailing address
388 SOUTH US HWY 20, BASIN, WY 82410-8902
(307) 568-3311
(307) 568-2139
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
261QR1300X
Rural Health Clinic/Center
06-139
WY
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110012203
—
WY
05
—
110012205
—
WY
05
—
115069300
—
WY
01
—
BLUE CROSS
722001
WY
Enumeration date
07/28/2006
Last updated
10/30/2023
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