# A WYOMING PAIN CLINIC P C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Powder River Pain Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164804480
- **Authorized official:** JOHN L. MANSELL MD (PROVIDER)
- **Authorized official phone:** (307) 696-2996

## Contact information

- **Practice address:** 3100 W LAKEWAY RD, SUITE 3, GILLETTE, WY 82718-6372
- **Practice address phone:** (307) 696-1475
- **Mailing address:** 8101 STONE CREST DR, GILLETTE, WY 82718-4006
- **Mailing address phone:** (307) 696-1475

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 7144A | WY | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 7144A | WY | Yes |
| 261QP3300X | Pain Clinic/Center | 7144A | WY | — |

## Other

- **Enumeration date:** 06/23/2015
- **Last updated:** 01/23/2024