Healthcare Provider Details

I. General information

NPI: 1356910426
Provider Name (Legal Business Name): BIGHORN VALLEY HEALTH CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 E MAIN ST
LOVELL WY
82431-2101
US

IV. Provider business mailing address

130 N BENT ST STE B
POWELL WY
82435-2742
US

V. Phone/Fax

Practice location:
  • Phone: 307-764-1602
  • Fax:
Mailing address:
  • Phone: 307-764-1602
  • Fax: 307-764-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DAVID ANDREW MARK
Title or Position: CEO
Credential: MD
Phone: 406-665-4103