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NPI Code Detail

MEDICARE: TETON MEDICAL GROUP PLLC

MEDICARE: TETON MEDICAL GROUP PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianM-10078ID

General Provider Information

NPI Number : 1154502615
Entity Type Code : Organization
Provider Name (Legal Business Name) : TETON MEDICAL GROUP PLLC
Provider Business Mailing Address
First Line : 32 WEST 1ST SOUTH
Second Line :
City : REXBURG
State : ID
Zip : 83440-1810
Country : US
Telephone Number : 208-356-7585
Fax Number : 208-356-7566
Provider Business Practice Location Address
First Line : 32 W 1ST S
Second Line :
City : REXBURG
State : ID
Zip : 83440-1810
Country : US
Telephone Number : 208-356-7585
Fax Number : 208-356-7566
Authorized Official
Title or Position : OWNER
Name : RICHARD THOMAS JONES
Credential : M.D.
Telephone Number : 208-356-7585
Provider Enumeration Date : 11/26/2007
Last Update Date : 07/16/2008

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