# GRAND TETON GASTROENTEROLOGY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Digestive Health Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457520900
- **Authorized official:** MRS. MELISSA DAWN LEMONS CCS-P (BILLING MANAGER)
- **Authorized official phone:** (208) 528-4255

## Contact information

- **Practice address:** 2770 CORTEZ AVE, IDAHO FALLS, ID 83404-7590
- **Practice address phone:** (208) 522-4000
- **Practice address fax:** (208) 528-4242
- **Mailing address:** 2770 CORTEZ AVE, IDAHO FALLS, ID 83404-7590
- **Mailing address phone:** (208) 522-4000
- **Mailing address fax:** (208) 528-4242

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | ID | Yes |

## Other

- **Enumeration date:** 02/28/2008
- **Last updated:** 02/29/2008