# LANDER VALLEY AMBULATORY SURGERY CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lander Outpatient Surgical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457548711
- **Authorized official:** DONALD J. BIVACCA (PRESIDENT)
- **Authorized official phone:** (615) 372-8500

## Contact information

- **Practice address:** 1320 BISHOP RANDALL DR, LANDER, WY 82520-3939
- **Practice address phone:** (307) 335-6565
- **Practice address fax:** (307) 335-6566
- **Mailing address:** 103 POWELL CT, BRENTWOOD, TN 37027-5079
- **Mailing address phone:** (615) 372-8500
- **Mailing address fax:** (615) 372-8572

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/01/2007
- **Last updated:** 10/03/2013