Organization
TETON MICROBIOLOGY LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RHYANNA KAY ROGERS (PRESIDENT OWNER)
(208) 529-0077
Entity
Organization
Contact information
Practice address
258 N WATER AVE, SUITE 2, IDAHO FALLS, ID 83402-4057
(208) 529-0077
(208) 522-3797
Mailing address
258 N WATER AVE, STE. 2, IDAHO FALLS, ID 83402-4057
(208) 529-0077
(208) 522-3797
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22387
BLUE SHIELD
ID
05
—
807270200
—
ID
01
—
8B164
BLUE CROSS
ID
Enumeration date
08/18/2006
Last updated
04/10/2012
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