Organization

Powell Valley Healthcare Inc.

May also be knows as Powell Valley Clinic

Legal Business Name

Powell Valley Healthcare Inc.

Also Known As

Powell Valley Clinic

NPI Number

1699721316

NPI Type

Organization

Enumeration Date

05/25/2006

Contact
Information

Purpose

Mailing
Location

Address

777 AVENUE H
777 AVENUE H

City

Powell
Powell

State

WY
WY

Postal Code

82435-2260
82435-2260

Country

US
US

Telephone Number

(307) 754-7257
(307) 754-7257

Authorized Official

Name

Terry Odom

Title or Position

CEO

Telephone Number

(307) 754-2267

Identifiers

Identifier

00903001
107186600
185760500
CG7216
107186601

Identifier State

WY
WY
WY
WY
WY

Identifier Issuer

BLUECROSS BLUESHIELD
Unknown
FEDERAL W/C
RAILROAD MEDICARE
Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 10/23/2020

Provider Address