Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
GRAND TETON SURGICAL CENTER LLC
Active
Organization
GRAND TETON SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA WELLARD R.N. (DIRECTOR OF NURSING)
(208) 524-3800
Entity
Organization
Contact information
Practice address
2290 CORONADO ST, IDAHO FALLS, ID 83404-7552
(208) 524-3800
(208) 524-3805
Mailing address
2290 CORONADO ST, IDAHO FALLS, ID 83404-7552
(208) 524-3800
(208) 524-3805
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005323
REGENCE BLUE SHIELD
ID
01
—
03772
BLUE CROSS
ID
05
—
805482600
—
ID
Enumeration date
06/14/2005
Last updated
03/02/2010
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up