Organization
TETON VALLEY HOSPITAL & SURGICENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN KUNZ (CHIEF EXECUTIVE OFFICER)
(208) 354-6317
Entity
Organization
Contact information
Practice address
120 E HOWARD ST, DRIGGS, ID 83422-5112
(208) 354-6317
Mailing address
120 E HOWARD ST, DRIGGS, ID 83422-5112
(208) 354-6317
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HH-184
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010033856
REGENCE BLUE SHIELD OF ID
ID
05
—
0022800
—
ID
01
—
02592
BLUE CROSS OF IDAHO
ID
Enumeration date
07/21/2006
Last updated
08/22/2020
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