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General NPI Number Information
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NPI Number | 1972658250
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Entity Type | Organization
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Legal Business Name | WYOMED LABORATORY, INC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 204 MCCOLLUM ST STE 105
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City | LARAMIE
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State | WY
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Zip | 82070-5151
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Country | US
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Telephone | 307-721-5111
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Fax | 307-745-5732
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Provider Business Mailing Address
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Address Line | 204 MCCOLLUM ST STE 105
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City | LARAMIE
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State | WY
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Zip | 82070-5151
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Country | US
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Telephone | 307-721-5111
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Fax | 307-745-5732
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GEORGIA JEAN CARMIN
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Credential | MT(ASCP)
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Telephone | 307-721-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | WY
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