Healthcare Provider Details

I. General information

NPI: 1801835475
Provider Name (Legal Business Name): TETON COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
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 Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number15109
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number15109
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL WATSON
Title or Position: CFO
Credential:
Phone: 307-739-7526