EVANSTON HOSPITAL CORPORATION (NPI# 1255304051) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255304051 |
| Entity Type | Organization |
| Organization Name | EVANSTON HOSPITAL CORPORATION |
| Other Organization Name | EVANSTON DIALYSIS CENTER |
| Practice Address |
112 Yellow Creek Rd Evanston WY 82930-9266 |
| Mailing Address |
190 Arrowhead Dr Evanston WY 82930-9266 |
| Practice Telephone | 3077893636 |
| Mailing Telephone | 3077893636 |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2020-09-03 |
| Authorized Official Name | RANDY MICHAEL COOPER (SVP FINANCE OPERATIONS/AO) |
| Authorized Official Telephone | 6152213840 |
| Is Organization Subpart | Y |
| Parent Organization Name | EVANSTON HOSPITAL CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
06-102 | WY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | 114835407 | 05 |
| Other Name | Type Code |
|---|---|
| Evanston Dialysis Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639140015 | Evanston Hospital Corporation | General Acute Care Hospital | 190 Arrowhead Dr, Evanston, WY 82930-9266 | 2006-02-01 |
| 1427595271 | Evanston Hospital Corporation | Clinic/Center | 531 Parkway Drive, Mountain View, WY 82939-0208 | 2017-01-31 |
| 1134666944 | Evanston Hospital Corporation | Clinic/Center | 107 N Main Street, Lyman, WY 82937-0001 | 2017-01-31 |
| 1366989014 | Evanston Hospital Corporation | Family Medicine | 107 N Main St., Lyman, WY 82937-0001 | 2017-01-19 |
| 1013288836 | Evanston Hospital Corporation | Nurse Anesthetist, Certified Registered | 190 Arrowhead Dr, Evanston, WY 82930-9266 | 2012-01-25 |
| 1801832548 | Evanston Hospital Corporation | Emergency Medicine | 190 Arrowhead Dr, Evanston, WY 82930-9266 | 2006-06-21 |
| 1356313506 | Evanston Hospital Corporation | Medicare Defined Swing Bed Unit | 190 Arrowhead Dr, Evanston, WY 82930-9266 | 2006-02-02 |
| Street Address |
112 YELLOW CREEK RD |
| City | EVANSTON |
| State | WY |
| Zip Code | 82930-9266 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598398935 | Colby Kim Gomez | Physical Therapist | 190 Arrowhead Dr, Evanston, Wy 82930, Evanston, WY 82930 | 2020-02-13 |
| 1164808382 | Marilyn Carol Edgeworth Tacoma | Registered Nurse | 1037 Morse Lee St, Evanston, WY 82930 | 2015-08-11 |
| 1699159723 | Impact Physical Therapy LLC | Clinic/Center | 96 Yellow Creek Road, Evanston, WY 82930 | 2015-07-18 |
| 1578942421 | Mark Carstensen | Case Manager/Care Coordinator | 219 7th Street, Evanston, WY 82930 | 2015-05-26 |
| 1013396241 | Jennifer Carstensen | Case Manager/Care Coordinator | 325 Arrowhead Drive, Evanston, WY 82930 | 2015-05-20 |
| 1780083782 | Christa Lena Barker | Nurse Practitioner | 191 Overthrust Road, Evanston, WY 82930 | 2014-08-15 |
| 1366865339 | Don Mckay Francom | Dentist | 170 Arrowhead Dr. Suite 1, Evanston, WY 82930 | 2014-01-28 |
| 1417228370 | Premier Surgical Center, LLC | Clinic/Center | 195 Overthrust Road, Evanston, WY 82930 | 2012-01-24 |
| 1588959324 | Mejia D Williams | Social Worker | 190 Overthrust Road, Evanston, WY 82930 | 2011-06-09 |
| 1225327000 | Richard Jay Capener | Family Medicine | 196 Arrowhead Dr Ste 1, Evanston, WY 82930 | 2011-04-01 |
| Find all providers in zip 82930 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508971359 | Dialysis Centers of America - Illinois, Inc. | Clinic/Center | 2953 Central St, Floor 1, Evanston, IL 60201-1245 | 2006-08-20 |
| 1689690893 | Isd Renal Inc | Clinic/Center | 1922 Dempster St, Evanston, IL 60202-1016 | 2006-07-14 |
| 1144415407 | Northshore University Healthsystem | Clinic/Center | 1301 Central St, Attn: Alexis Washa, Evanston, IL 60201-1613 | 2007-09-10 |
| 1437199791 | Northshore University Healthsystem | Clinic/Center | 2650 Ridge Ave, Evanston, IL 60201-1718 | 2006-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306392261 | Usrc Casper, LLC | Clinic/Center | 1300 Venture Way, Suite 100, Casper, WY 82609-4353 | 2016-08-31 |
| 1790824530 | Shoshone Tribe | Clinic/Center | 11 Shipton Lane, Fort Washakie, WY 82514 | 2007-02-06 |
| 1952413759 | Bio-medical Applications of Wyoming LLC | Clinic/Center | 1739 Meadowland Drive, Cheyenne, WY 82009-5249 | 2006-08-31 |
| 1508837865 | Wyoming Kidney Center, LLC | Clinic/Center | 1141 Wilkins Cir, Casper, WY 82601-1332 | 2006-01-26 |
| 1730562372 | Watt Dialysis Center LLC | Clinic/Center | 1401 W 5th St, Sheridan, WY 82801-2705 | 2015-07-01 |
| 1669818969 | Big Horn Basin Regional Dialysis Center LLC | Clinic/Center | 424 Yellowstone Ave, Suite 150, Cody, WY 82414-9309 | 2013-05-14 |
| 1609932383 | Billings Clinic | Clinic/Center | 1401 W 5th St, Sheridan, WY 82801-2705 | 2006-12-28 |
| 1295815744 | West Park Hospital District | Clinic/Center | 707 Sheridan Ave, Cody, WY 82414-3409 | 2006-10-17 |
| 1144313255 | Campbell County Hospital District | Clinic/Center | 501 S Burma Ave, Gillette, WY 82716-3426 | 2006-10-02 |
Please comment or provide details below to improve the information on EVANSTON HOSPITAL CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.