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
Specialties
(Taxonomies)Name
Code
207L00000X
2085R0202X
207P00000X
207R00000X
207V00000X
207XS0106X
207X00000X
208000000X
208600000X
Primary Taxonomy
No
No
No
No
No
No
No
No
No
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