MEDICARE: TETON COUNTY HOSPITAL DISTRICT

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
1	251G00000X	Community Based Hospice Care Agency	15121	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568493989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TETON COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 428
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-0428
Country	:	US
Telephone Number	:	307-739-6135
Fax Number	:	307-414-4729

Provider Business Practice Location Address
First Line	:	555 E BROADWAY AVE
Second Line	:	SUITE #115
City	:	JACKSON
State	:	WY
Zip	:	83001-8640
Country	:	US
Telephone Number	:	307-739-7465
Fax Number	:	307-739-7645

Authorized Official
Title or Position	:	CFO
Name	:	MITCHELL WATSON
Credential	:
Telephone Number	:	307-739-7526

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	02/02/2026

Similar Medicare Providers

1194744235 — TETON COUNTY HOSPITAL DISTRICT
Practice Location Address:

555 E BROADWAY AVE , STE 115
JACKSON, WY
83001-8640

Practice Phone: 307-739-7465
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1164414744 — DR. TRAER GARY CAYWOOD O.D.
Practice Location Address:

555 E BROADWAY AVE STE 214
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1699752089 — KATHLEEN M LOGAN M.D.
Practice Location Address:

555 E BROADWAY AVE STE 204
JACKSON, WY
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1659345221 — DR. MICHAEL WARD ROSENBERG M.D.
Practice Location Address:

555 E BROADWAY AVE , SUITE #229
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1467400747 — GLENN EDWARD BURNETT II MD
Practice Location Address:

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1669423273 — MAURA JEAN LOFARO M.D.
Practice Location Address:

555 E BROADWAY AVE , SUITE 108
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Practice Phone: 307-734-1005
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Directions to “TETON COUNTY HOSPITAL DISTRICT ” Practice Location

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