Healthcare Provider Details

I. General information

NPI: 1497753115
Provider Name (Legal Business Name): POWELL VALLEY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 AVENUE H
POWELL WY
82435
US

IV. Provider business mailing address

777 AVENUE H
POWELL WY
82435-2260
US

V. Phone/Fax

Practice location:
  • Phone: 307-754-1101
  • Fax: 307-754-3176
Mailing address:
  • Phone: 307-754-2267
  • Fax: 307-754-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number07084
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number10207
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number065
License Number StateWY

VIII. Authorized Official

Name: MRS. TERRY ODOM
Title or Position: CEO
Credential:
Phone: 307-754-1107