Provider Demographics
NPI:1427037407
Name:JOHNSON COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:JOHNSON COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-684-5521
Mailing Address - Street 1:497 WEST LOTT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1609
Mailing Address - Country:US
Mailing Address - Phone:307-684-5521
Mailing Address - Fax:307-684-5385
Practice Address - Street 1:497 WEST LOTT
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1609
Practice Address - Country:US
Practice Address - Phone:307-684-5521
Practice Address - Fax:307-684-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY52012533336L0003X
WY06108311500000X, 313M00000X, 315D00000X
311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106561101Medicaid
WY106561103Medicaid