Provider Demographics
NPI:1952739633
Name:WYOMING PUBLIC HEALTH LABORATORY
Entity type:Organization
Organization Name:WYOMING PUBLIC HEALTH LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:WALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:307-777-6053
Mailing Address - Street 1:208 S COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2600
Mailing Address - Country:US
Mailing Address - Phone:307-777-7431
Mailing Address - Fax:307-777-6422
Practice Address - Street 1:208 S COLLEGE DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2600
Practice Address - Country:US
Practice Address - Phone:307-777-7431
Practice Address - Fax:307-777-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory