Provider Demographics
NPI:1437294972
Name:GLENROCK HOSPITAL DISTRICT
Entity type:Organization
Organization Name:GLENROCK HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OVIEDO-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNPC
Authorized Official - Phone:307-436-9206
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:925 W BIRCH
Mailing Address - City:GLENROCK
Mailing Address - State:WY
Mailing Address - Zip Code:82637-0786
Mailing Address - Country:US
Mailing Address - Phone:307-436-9206
Mailing Address - Fax:307-436-9730
Practice Address - Street 1:925 W BIRCH STREET
Practice Address - Street 2:
Practice Address - City:GLENROCK
Practice Address - State:WY
Practice Address - Zip Code:82637-0786
Practice Address - Country:US
Practice Address - Phone:307-436-9206
Practice Address - Fax:307-436-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY108690100Medicaid
WY108690100Medicaid