Provider Demographics
NPI:1558400192
Name:POWELL VALLEY HEALTH CARE INC
Entity type:Organization
Organization Name:POWELL VALLEY HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:307-754-1125
Mailing Address - Street 1:777 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2260
Mailing Address - Country:US
Mailing Address - Phone:307-754-2267
Mailing Address - Fax:307-754-1176
Practice Address - Street 1:777 AVENUE H
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2260
Practice Address - Country:US
Practice Address - Phone:307-754-2267
Practice Address - Fax:307-754-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5201342333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5201342OtherNCPDP
WY107049500Medicaid
WY107049502Medicaid
WY107185807Medicaid
WY007203OtherBCBS PROVIDER #
WY007203OtherBCBS PROVIDER #
WY007203OtherBCBS PROVIDER #
WY1055000001Medicare NSC
WY=========OtherTAX ID #