Basic Information
| Provider Information | |||||||||
| NPI: | 1861590358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANEY | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | KEITH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2695 ROCKY MOUNTAIN AVE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805388702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706244443 | ||||||||
| FaxNumber: | 9704904175 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 E PROSPECT RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805255306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704824373 | ||||||||
| FaxNumber: | 9704845682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 01083262 | IN | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 44994 | CO | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 123552400 | 05 | WY | MEDICAID | LA801107 | 01 | CO | ANTHEM BCBS | OTHER | P00382506 | 01 | RAILROAD MEDICARE | OTHER | 10603719 | 05 | CO | MEDICAID |