# POWELL VALLEY HEALTH CARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104965003
- **Authorized official:** MS. TERRY ODOM CEO (CEO)
- **Authorized official phone:** (307) 754-1179

## Contact information

- **Practice address:** 777 AVENUE H, POWELL, WY 82435-2260
- **Practice address phone:** (307) 754-1125
- **Practice address fax:** (307) 754-1176
- **Mailing address:** 777 AVENUE H, POWELL, WY 82435-2260
- **Mailing address phone:** (307) 754-1125
- **Mailing address fax:** (307) 754-1176

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336I0012X | Institutional Pharmacy | 5201342 | WY | Yes |
| 3336L0003X | Long Term Care Pharmacy | 5201342 | WY | — |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 03/07/2023

## 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 |