Organization
LANDER VALLEY PHYSICIAN PRACTICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESS N JUDY (PRESIDENT)
(615) 372-8500
Entity
Organization
Contact information
Practice address
830 LINCOLN ST, LANDER, WY 82520-2736
(307) 332-9577
(307) 332-3106
Mailing address
830 LINCOLN ST, LANDER, WY 82520-2736
(307) 332-9577
(307) 332-3106
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
174400000X
Specialist
6909A
WY
207R00000X
Internal Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119703700
—
WY
Enumeration date
06/16/2006
Last updated
01/02/2013
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