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Organization
LANDER MEDICAL CLINIC, PC
Active
Organization
LANDER MEDICAL CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN L HEDGES (CEO)
(307) 332-2941
Entity
Organization
Contact information
Practice address
745 BUENA VISTA, LANDER, WY 82520-3431
(307) 332-2941
(307) 332-1920
Mailing address
PO BOX 9432, BELFAST, ME 04915-9432
(307) 332-2941
(307) 332-1920
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
WY
332B00000X
Durable Medical Equipment & Medical Supplies
0823410001
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00975001
BLUE SHIELD OF WYOMING
WY
01
—
0823410001
MEDICARE DMEPOS
WY
05
—
106224700
—
WY
01
—
CT0209
MEDICARE RAILROAD RETIREM
WY
Enumeration date
10/13/2006
Last updated
04/03/2015
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