- Enrollment id
- O20120510000515
- Enrollment state
- WY
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1891774873
- Multiple npi flag
- N
- Ccn
- 531506
- Associate id
- 5193610947
- Organization name
- JOHNSON COUNTY MEMORIAL HOSPITAL
- Doing business as name
- SUSIE BOWLING LAWRENCE HOSPICE
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Address line 1
- 497 W LOTT ST
- City
- BUFFALO
- State
- WY
- Zip code
- 828341658