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NPI Code Detail

MEDICARE: LANDER VALLEY MEDICAL CENTER LLC

MEDICARE: LANDER VALLEY MEDICAL CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1275N00000XMedicare Defined Swing Bed Hospital Unit

General Provider Information

NPI Number : 1942396585
Entity Type Code : Organization
Provider Name (Legal Business Name) : LANDER VALLEY MEDICAL CENTER LLC
Provider Business Mailing Address
First Line : 330 SEVEN SPRINGS WAY
Second Line :
City : BRENTWOOD
State : TN
Zip : 37027-4536
Country : US
Telephone Number : 615-920-7000
Fax Number : 615-920-8913
Provider Business Practice Location Address
First Line : 1320 BISHOP RANDALL DR
Second Line :
City : LANDER
State : WY
Zip : 82520-3939
Country : US
Telephone Number : 307-332-4420
Fax Number : 307-332-3548
Authorized Official
Title or Position : PRESIDENT
Name : DONALD J. BIVACCA
Credential :
Telephone Number : 615-920-7000
Provider Enumeration Date : 10/04/2006
Last Update Date : 05/02/2014

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Directions to “LANDER VALLEY MEDICAL CENTER LLC ” Practice Location

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