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Organization
POWELL VALLEY HEALTH CARE, INC.
Active
Organization
POWELL VALLEY HEALTH CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRY ODOM CEO (CEO)
(307) 754-1179
Entity
Organization
Contact information
Practice address
777 AVENUE H, POWELL, WY 82435-2260
(307) 754-1125
(307) 754-1176
Mailing address
777 AVENUE H, POWELL, WY 82435-2260
(307) 754-1125
(307) 754-1176
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
NULL
3336I0012X
Institutional Pharmacy
Primary
5201342
WY
3336L0003X
Long Term Care Pharmacy
5201342
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007203
BCBS PROVIDER #
WY
05
—
107049500
—
WY
05
—
107049502
—
WY
05
—
107185807
—
WY
01
—
520134
PART D CAREMARXK PROVIDER
WY
01
—
5201342
PART D AETNA PROVIDER #
WY
Enumeration date
02/06/2007
Last updated
03/07/2023
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