Provider Demographics
NPI:1063040731
Name:POWDER RIVER SURGERY CENTER
Entity Type:Organization
Organization Name:POWDER RIVER SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-688-8600
Mailing Address - Street 1:906 W 6TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3435
Mailing Address - Country:US
Mailing Address - Phone:307-688-8600
Mailing Address - Fax:307-682-3432
Practice Address - Street 1:906 W 6TH ST STE C
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3435
Practice Address - Country:US
Practice Address - Phone:307-688-8600
Practice Address - Fax:307-682-3432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical