Organization
POWDER RIVER ORTHOPEDICS & SPINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE M MORDECAI (OFFICE MANAGER)
(307) 686-1413
Entity
Organization
Contact information
Practice address
508 STOCKTRAIL AVE, STE A, GILLETTE, WY 82716-3582
(307) 686-1413
(307) 682-1113
Mailing address
508 STOCKTRAIL AVE, STE A, GILLETTE, WY 82716-3582
(307) 686-1413
(307) 682-1113
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00845001
BCBS
WY
Enumeration date
09/02/2005
Last updated
11/01/2007
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