Provider Demographics
NPI:1902106628
Name:SUBLETTE COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:SUBLETTE COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-367-2157
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:619 E HENNICK ST
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941
Mailing Address - Country:US
Mailing Address - Phone:307-367-2157
Mailing Address - Fax:307-367-2689
Practice Address - Street 1:619 E HENNICK ST
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941
Practice Address - Country:US
Practice Address - Phone:307-367-2157
Practice Address - Fax:307-367-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY25380163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308197Medicare UPIN