Provider Demographics
NPI:1811185184
Name:TETON WOMEN'S HEALTH CENTER
Entity Type:Organization
Organization Name:TETON WOMEN'S HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OLDROYD
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:208-523-2060
Mailing Address - Street 1:2001 S WOODRUFF AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6372
Mailing Address - Country:US
Mailing Address - Phone:208-523-2060
Mailing Address - Fax:208-523-9874
Practice Address - Street 1:2001 S WOODRUFF AVE STE 10
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6372
Practice Address - Country:US
Practice Address - Phone:208-523-2060
Practice Address - Fax:208-523-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3475207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1374524Medicare PIN