Provider Demographics
NPI:1053669598
Name:TETON VALLEY HEALTH CARE, INC
Entity Type:Organization
Organization Name:TETON VALLEY HEALTH CARE, INC
Other - Org Name:TETON VALLEY HEALTH CARE SWING BED UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF COMPLIANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-354-6302
Mailing Address - Street 1:120 E HOWARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-5112
Mailing Address - Country:US
Mailing Address - Phone:208-354-2383
Mailing Address - Fax:208-354-3158
Practice Address - Street 1:120 E HOWARD AVENUE
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5112
Practice Address - Country:US
Practice Address - Phone:208-354-2383
Practice Address - Fax:208-354-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID31275N00000X, 282NC0060X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID13Z313Medicare Oscar/Certification
ID131313Medicare Oscar/Certification