Organization
TETON VALLEY HEALTHCARE, INC
Active
Parent organization
TETON VALLEY HEALTHCARE, INC
Other names
Cache Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
TETON VALLEY HEALTHCARE, INC
Authorized official
LAURA C PIQUET (DIRECTOR OF COMPLIANCE)
(208) 354-6302
Entity
Organization
Contact information
Practice address
30 E LITTLE AVE, DRIGGS, ID 83422-5138
(208) 354-6302
(208) 354-3158
Mailing address
120 E HOWARD ST, DRIGGS, ID 83422-5112
(208) 354-6302
(208) 354-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31
ID
363AM0700X
Medical Physician Assistant
31
ID
363LF0000X
Family Nurse Practitioner
31
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6
RETAIL CLINIC
—
Enumeration date
09/15/2016
Last updated
09/15/2016
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