Healthcare Provider Details

I. General information

NPI: 1740818541
Provider Name (Legal Business Name): LANDER LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 03/29/2020
Certification Date: 03/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 N 2ND ST
LANDER WY
82520-2202
US

IV. Provider business mailing address

890 N 2ND ST
LANDER WY
82520-2202
US

V. Phone/Fax

Practice location:
  • Phone: 307-349-8521
  • Fax: 801-459-1200
Mailing address:
  • Phone: 307-349-8521
  • Fax: 801-459-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MORGAN FALLS
Title or Position: CONTRACTING ADMINISTRATOR
Credential:
Phone: 307-349-8521