STATE OF WYOMING (NPI# 1316011562) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316011562 |
| Entity Type | Organization |
| Organization Name | STATE OF WYOMING |
| Other Organization Name | WYOMING STATE HOSPITAL |
| Practice Address |
831 State Highway 150 S Evanston WY 82930-5340 |
| Practice Telephone | 3077893464 |
| Practice Fax Number | 3077897373 |
| Mailing Telephone | 3077893464 |
| Mailing Fax Number | 3077897373 |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2015-11-12 |
| Authorized Official Name | MR. PAUL MULLENAX (BUSINESS MANAGER) |
| Authorized Official Telephone | 3077893464 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208D00000X | General Practice | 15163 | WY | Allopathic & Osteopathic Physicians |
| Y | 283Q00000X | Psychiatric Hospital | 15163 | WY | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | NATIONAL PROVIDER IDENTIFIER | 1316011562 | 01 |
| Other Name | Type Code |
|---|---|
| Wyoming State Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093337990 | State of Wyoming | Skilled Nursing Facility | 8204 Wyoming Highway 789, Lander, WY 82520-2941 | 2020-05-13 |
| 1659328821 | State of Wyoming | Skilled Nursing Facility | 890 Highway 20 S, Basin, WY 82410-9587 | 2006-05-31 |
| 1023154564 | State of Wyoming | Pharmacy | 8204 State Highway 789, Lander, WY 82520-2941 | 2007-01-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | STATE OF WYOMING PUBLIC DEFENDERS | 316 W 22nd St, Cheyenne, WY 82001-3676 |
| Street Address |
831 STATE HIGHWAY 150 S |
| City | EVANSTON |
| State | WY |
| Zip Code | 82930-5340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306936117 | Dawn Lynn Stewart | Psychiatry & Neurology | 831 State Highway 150 S, Evanston, WY 82930-5340 | 2006-10-13 |
| 1982807145 | James Bruce Whiting | Dentist | 831 State Highway 150 S, Evanston, WY 82930-5340 | 2007-06-06 |
| 1265562482 | Candyce Lynn Shields | Psychologist | 831 State Highway 150 S, Evanston, WY 82930-5340 | 2007-03-06 |
| 1922135177 | Rex G Mabey | Psychiatry & Neurology | 831 State Highway 150 S, Evanston, WY 82930-5340 | 2007-02-27 |
| 1528194115 | Kathryn Anderson | Psychologist | 831 State Highway 150 S, Evanston, WY 82930-5340 | 2007-02-26 |
| 1912033515 | Cathy Buckwell | Psychologist | 831 State Highway 150 S, Evanston, WY 82930-5340 | 2007-02-26 |
| 1790830792 | Philip Sullivan | Psychiatry & Neurology | 831 State Highway 150 S, Evanston, WY 82930-5340 | 2007-01-23 |
| 1912052903 | Julie B Maggiolo | Psychiatry & Neurology | 831 State Highway 150 S, Evanston, WY 82930-5340 | 2007-01-23 |
| 1497800478 | Patricia A.e. Verellen | Psychiatry & Neurology | 831 State Highway 150 S, Evanston, WY 82930-5340 | 2007-01-23 |
| 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 | 283Q00000X |
| Grouping | Hospitals |
| Classification | Psychiatric Hospital |
| An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings. |
| Notes: Source: Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295818870 | Wyoming Behavioral Institute | Psychiatric Hospital | 518 N Us Highway 14-16, Unit D, Gillette, WY 82716-3305 | 2006-10-24 |
| 1295764512 | Wyoming Behavioral Institute | Psychiatric Hospital | 2417 E 15th St, Casper, WY 82609-2942 | 2006-06-30 |
| 1972503506 | Wyoming Behavioral Institute, LLC | Psychiatric Hospital | 2521 E 15th St, Casper, WY 82609-4126 | 2005-07-26 |
Please comment or provide details below to improve the information on STATE OF WYOMING.
| 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.