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General NPI Number Information
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NPI Number | 1053669598
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Entity Type | Organization
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Legal Business Name | TETON VALLEY HEALTH CARE, INC
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 120 E HOWARD AVENUE
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City | DRIGGS
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State | ID
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Zip | 83422-5112
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Country | US
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Telephone | 208-354-2383
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Fax | 208-354-3158
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Provider Business Mailing Address
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Address Line | 120 E HOWARD AVENUE
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City | DRIGGS
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State | ID
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Zip | 83422-5112
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Country | US
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Telephone | 208-354-2383
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Fax | 208-354-3158
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Authorized Official
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Title or Position | CHIEF OF COMPLIANCE
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Name | MRS. JILL PAYNE
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Credential |
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Telephone | 208-354-6302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 31
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 31
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 31
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License Number State | ID
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