NPIMap

Organization Active NPI

Powell Valley Health Care, Inc.

  • Institutional Pharmacy
  • Powell, WY
National Provider Identifier
1104965003
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
5201342 Issued in WY
Legal business name
POWELL VALLEY HEALTH CARE, INC.
Practice address
777 Avenue H
Powell, WY 82435-2260
Phone
(307) 754-1125
Fax
(307) 754-1176
NPI assigned
Feb 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Terry Odom, CEO
Title
Ceo
Phone
(307) 754-1179

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X
Institutional Pharmacy 3336I0012X 5201342 WY Primary
Long Term Care Pharmacy 3336L0003X 5201342 WY

Addresses

Primary practice location

777 Avenue H
Powell, WY 82435-2260

Mailing address

777 Avenue H
Powell, WY 82435-2260
Phone (307) 754-1125

Other identifiers 8

IdentifierTypeStateIssuer
007203OtherWYBCBS PROVIDER #
5201342OtherWYPART D RX SOLUTIONS PROV
107049500MedicaidWY
107049502MedicaidWY
107185807MedicaidWY
520134OtherWYPART D CAREMARXK PROVIDER
5201342OtherWYPART D AETNA PROVIDER #
5201342OtherWYNCPDP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200526001911 WY Part B Supplier - Pharmacy 5092798561 Practice locations: Powell, WY

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Powell Hospital6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1104965003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 AVENUE H",
            "city": "POWELL",
            "state": "WY",
            "postal_code": "824352260",
            "telephone_number": "307-754-1125",
            "fax_number": "307-754-1176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 AVENUE H",
            "city": "POWELL",
            "state": "WY",
            "postal_code": "824352260",
            "telephone_number": "307-754-1125",
            "fax_number": "307-754-1176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWELL VALLEY HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2023-03-07",
        "certification_date": "2022-01-10",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-754-1179",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "WY",
            "license": "5201342",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "WY",
            "license": "5201342",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "007203",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART D RX SOLUTIONS PROV",
            "identifier": "5201342",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107049500",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107049502",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107185807",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART D CAREMARXK PROVIDER",
            "identifier": "520134",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART D AETNA PROVIDER #",
            "identifier": "5201342",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5201342",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Powell, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.