Healthcare Provider Details

I. General information

NPI: 1972658250
Provider Name (Legal Business Name): WYOMED LABORATORY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MCCOLLUM ST STE 105
LARAMIE WY
82070-5151
US

IV. Provider business mailing address

204 MCCOLLUM ST STE 105
LARAMIE WY
82070-5151
US

V. Phone/Fax

Practice location:
  • Phone: 307-721-5111
  • Fax: 307-745-5732
Mailing address:
  • Phone: 307-721-5111
  • Fax: 307-745-5732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. GEORGIA JEAN CARMIN
Title or Position: PRESIDENT
Credential: MT(ASCP)
Phone: 307-721-5111