Organization
LANDER VALLEY AMBULATORY SURGERY CENTER LLC
Active
Other names
Lander Outpatient Surgical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD J. BIVACCA (PRESIDENT)
(615) 372-8500
Entity
Organization
Contact information
Practice address
1320 BISHOP RANDALL DR, LANDER, WY 82520-3939
(307) 335-6565
(307) 335-6566
Mailing address
103 POWELL CT, BRENTWOOD, TN 37027-5079
(615) 372-8500
(615) 372-8572
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
10/01/2007
Last updated
10/03/2013
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