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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