# GRAND TETON MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891997151
- **Authorized official:** DR. BRENT BLUE M.D. (CLINIC OWNER)
- **Authorized official phone:** (307) 733-8002

## Contact information

- **Practice address:** INNER LOOP ROAD, JACKSON LAKE LODGE, MORAN, WY 83013
- **Practice address phone:** (307) 543-2514
- **Practice address fax:** (307) 543-2514
- **Mailing address:** PO BOX 15240, JACKSON, WY 83002-5240
- **Mailing address phone:** (307) 733-8002
- **Mailing address fax:** (307) 733-0032

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/31/2007
- **Last updated:** 08/02/2007