Provider Demographics
NPI:1871660159
Name:CROOK COUNTY MEDICAL SERVICES DISTRICT
Entity type:Organization
Organization Name:CROOK COUNTY MEDICAL SERVICES DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:DAHNE
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:307-283-3501
Mailing Address - Street 1:713 OAK STREET
Mailing Address - Street 2:PO BOX 517
Mailing Address - City:SUNDANCE
Mailing Address - State:WY
Mailing Address - Zip Code:82729-0517
Mailing Address - Country:US
Mailing Address - Phone:307-283-3501
Mailing Address - Fax:307-283-2255
Practice Address - Street 1:713 OAK STREET
Practice Address - Street 2:
Practice Address - City:SUNDANCE
Practice Address - State:WY
Practice Address - Zip Code:82729-0517
Practice Address - Country:US
Practice Address - Phone:307-283-3501
Practice Address - Fax:307-283-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07-127282NC0060X
313M00000X, 314000000X, 315D00000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106168200Medicaid
WY106168202Medicaid
WY106168211Medicaid
WY106168203Medicaid
WY106168204Medicaid
WY106168200Medicaid
WY106168203Medicaid
WY531311Medicare Oscar/Certification