Healthcare Provider Details

I. General information

NPI: 1487818605
Provider Name (Legal Business Name): TETON COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E BROADWAY AVE
JACKSON WY
83001-8642
US

IV. Provider business mailing address

PO BOX 428
JACKSON WY
83001-0428
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-3636
  • Fax: 877-205-2024
Mailing address:
  • Phone: 307-733-3636
  • Fax: 877-205-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15109
License Number StateWY

VIII. Authorized Official

Name: JOHN KREN
Title or Position: COO/CFO
Credential:
Phone: 307-739-7526