Organization
TETON CARDIOVASCULAR AND PULMONARY LAB,LLC
Active
Other names
Snake River Cardiovascular & Pulmonary Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
BRADEN L CAZARES (CEO)
(972) 677-3896
Entity
Organization
Contact information
Practice address
2001 S WOODRUFF AVE, SUITE 12 B, IDAHO FALLS, ID 83404-6374
(800) 341-1043
(208) 528-7971
Mailing address
PO BOX 2559, BURLESON, TX 76097-2559
(800) 341-1043
(208) 528-7971
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010153937
BLUE SHIELD OF IDAHO
ID
05
—
807391800
—
ID
01
—
8M795
BLUE CROSS OF IDAHO
ID
Enumeration date
08/08/2006
Last updated
05/06/2025
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