# TETON VALLEY HOSITAL & SURGICENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TETON VALLEY HOSPITAL & SURGICENTER
- **Other names:** Victor Medical Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1881734135
- **Legal business name:** TETON VALLEY HOSPITAL & SURGICENTER
- **Authorized official:** MRS. LAURA C PIQUET (OPERATIONS MANAGER)
- **Authorized official phone:** (208) 354-6302

## Contact information

- **Practice address:** 252 SOUTH MAIN STREET, VICTOR, ID 83455
- **Practice address phone:** (208) 354-6307
- **Practice address fax:** (208) 787-7456
- **Mailing address:** 120 EAST HOWARD AVENUE, DRIGGS, ID 83422-5112
- **Mailing address phone:** (208) 354-6307
- **Mailing address fax:** (208) 787-7456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 31 | ID | — |
| 207Q00000X | Family Medicine Physician | 31 | ID | Yes |
| 207X00000X | Orthopaedic Surgery Physician | 31 | ID | — |
| 208000000X | Pediatrics Physician | 31 | ID | — |
| 208600000X | Surgery Physician | 31 | ID | — |
| 208800000X | Urology Physician | 31 | ID | — |
| 208VP0014X | Interventional Pain Medicine Physician | 31 | ID | — |

## Other

- **Enumeration date:** 02/07/2007
- **Last updated:** 11/18/2010