Organization
A WYOMING PAIN CLINIC P C
Active
Other names
Powder River Pain Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN L. MANSELL MD (PROVIDER)
(307) 696-2996
Entity
Organization
Contact information
Practice address
3100 W LAKEWAY RD, SUITE 3, GILLETTE, WY 82718-6372
(307) 696-1475
Mailing address
8101 STONE CREST DR, GILLETTE, WY 82718-4006
(307) 696-1475
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
7144A
WY
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
7144A
WY
261QP3300X
Pain Clinic/Center
7144A
WY
Other
Enumeration date
06/23/2015
Last updated
01/23/2024
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