# LANDER VALLEY MEDICAL CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538207584
- **Authorized official:** DONALD J. BIVACCA (PRESIDENT)
- **Authorized official phone:** (615) 920-7000

## Contact information

- **Practice address:** 1320 BISHOP RANDALL DR, LANDER, WY 82520-3939
- **Practice address phone:** (307) 332-4420
- **Mailing address:** 330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-4536
- **Mailing address phone:** (615) 920-7000
- **Mailing address fax:** (615) 920-8913

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 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