Organization
POWELL VALLEY HEALTH CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY ODOM (CEO)
(307) 754-2267
Entity
Organization
Contact information
Practice address
777 AVENUE H, POWELL, WY 82435-2260
(307) 754-1101
(307) 754-3179
Mailing address
777 AVENUE H, POWELL, WY 82435-2260
(307) 754-1101
(307) 754-3179
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
07084
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007203
BCBS PROVIDER #
WY
05
—
107185804
—
WY
Enumeration date
12/12/2006
Last updated
10/06/2015
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