| NPI | 1164804480 |
|---|---|
| Doing Business As | POWDER RIVER PAIN CLINIC |
| Entity Type | Organization |
| Authorized Contact | JOHN L. MANSELL Provider 307-696-2996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WY 7144A) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WY 7144A) |
| 261QP3300X Clinic/Center, Pain (Licence: WY 7144A) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2024-01-23 |