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General NPI Number Information
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NPI Number | 1386521292
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Entity Type | Organization
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Legal Business Name | POWER BASIN HEALTHCARE LLC
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 101 W CROOK STREET
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City | MORECROFT
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State | WY
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Zip | 82721-5027
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Country | US
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Telephone | 307-756-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W CROOK STREET
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City | MORECROFT
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State | WY
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Zip | 82721-5027
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Country | US
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Telephone | 307-756-9200
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | AMBER L TUELLER
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Credential |
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Telephone | 208-207-2726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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