Organization
TETON VALLEY HEALTH CARE, INC
Active
Organization
TETON VALLEY HEALTH CARE, INC
Active
Other names
Victor Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JILL PAYNE PAYNE (CHIEF OF COMPLIANCE)
(208) 354-6352
Entity
Organization
Contact information
Practice address
83 N MAIN ST, VICTOR, ID 83455-0368
(208) 354-6307
(208) 787-7456
Mailing address
120 E HOWARD ST, DRIGGS, ID 83422-5112
(208) 354-6302
(208) 354-3158
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
ID
207Q00000X
Family Medicine Physician
—
ID
207X00000X
Orthopaedic Surgery Physician
—
ID
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
ID
208000000X
Pediatrics Physician
—
ID
208600000X
Surgery Physician
31
ID
208VP0014X
Interventional Pain Medicine Physician
31
ID
261QR1300X
Rural Health Clinic/Center
Primary
31
ID
363AM0700X
Medical Physician Assistant
—
ID
363L00000X
Nurse Practitioner
—
ID
363LP0200X
Pediatric Nurse Practitioner
—
ID
Other
Enumeration date
08/07/2012
Last updated
02/20/2020
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