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General NPI Number Information
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NPI Number | 1497753115
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Entity Type | Organization
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Legal Business Name | POWELL VALLEY HEALTH CARE INC
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435
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Country | US
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Telephone | 307-754-1101
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Fax | 307-754-3176
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Provider Business Mailing Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435-2260
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Country | US
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Telephone | 307-754-2267
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Fax | 307-754-3176
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Authorized Official
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Title or Position | CEO
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Name | MRS. TERRY ODOM
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Credential |
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Telephone | 307-754-1107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 10207
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 065
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 07084
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License Number State | WY
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