Organization
LANDER MEDICAL CLINIC, P.C.
Active
Other names
Lander Medical Clinic DMEPOS
Organization subpart
No
Provider details
NPI number
Authorized official
BROC CODI WHITE MD (PRESIDENT)
(307) 332-2941
Entity
Organization
Contact information
Practice address
745 BUENA VISTA DR, LANDER, WY 82520-3431
(307) 332-2941
(307) 332-2068
Mailing address
745 BUENA VISTA DR, LANDER, WY 82520-3431
(307) 332-2941
(307) 332-2068
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0823410001
MEDICARE DMEPOS
WY
05
—
143593100
—
WY
Enumeration date
08/01/2007
Last updated
09/16/2024
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