MEDICARE: POWER BASIN HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1386521292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWER BASIN HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	101 W CROOK STREET
Second Line	:
City	:	MORECROFT
State	:	WY
Zip	:	82721-5027
Country	:	US
Telephone Number	:	307-756-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W CROOK STREET
Second Line	:
City	:	MORECROFT
State	:	WY
Zip	:	82721-5027
Country	:	US
Telephone Number	:	307-756-9200
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	AMBER L TUELLER
Credential	:
Telephone Number	:	208-207-2726

Provider Enumeration Date	:	08/20/2025
Last Update Date	:	09/18/2025

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Directions to “POWER BASIN HEALTHCARE LLC ” Practice Location

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