Healthcare Provider Details

I. General information

NPI: 1346107778
Provider Name (Legal Business Name): DEER VALLEY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 7TH ST
GORDON NE
69343-1053
US

IV. Provider business mailing address

405 W 7TH ST
GORDON NE
69343-1053
US

V. Phone/Fax

Practice location:
  • Phone: 308-299-8518
  • Fax: 949-817-0772
Mailing address:
  • Phone: 308-299-8518
  • Fax: 949-817-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANPO WICAHPI CHARGING THUNDER
Title or Position: OWNER, PHYSICIAN
Credential: MD
Phone: 308-299-8518