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Organization
LANDER VALLEY MEDICAL CENTER LLC
Active
Organization
LANDER VALLEY MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD J. BIVACCA (PRESIDENT)
(615) 920-7000
Entity
Organization
Contact information
Practice address
1320 BISHOP RANDALL DR, LANDER, WY 82520-3939
(307) 332-4420
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-4536
(615) 920-7000
(615) 920-8913
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
NULL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
Other
Enumeration date
02/02/2007
Last updated
07/22/2014
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