Organization
TETON VALLEY HOSITAL & SURGICENTER
Active
Parent organization
TETON VALLEY HOSPITAL & SURGICENTER
Other names
Victor Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
TETON VALLEY HOSPITAL & SURGICENTER
Authorized official
MRS. LAURA C PIQUET (OPERATIONS MANAGER)
(208) 354-6302
Entity
Organization
Contact information
Practice address
252 SOUTH MAIN STREET, VICTOR, ID 83455
(208) 354-6307
(208) 787-7456
Mailing address
120 EAST HOWARD AVENUE, DRIGGS, ID 83422-5112
(208) 354-6307
(208) 787-7456
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
31
ID
207Q00000X
Family Medicine Physician
Primary
31
ID
207X00000X
Orthopaedic Surgery Physician
31
ID
208000000X
Pediatrics Physician
31
ID
208600000X
Surgery Physician
31
ID
208800000X
Urology Physician
31
ID
208VP0014X
Interventional Pain Medicine Physician
31
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010031568
REGENCE BLUE SHIELD
ID
05
—
807736300
—
ID
01
—
8M954
BLUE CROSS
ID
Enumeration date
02/07/2007
Last updated
11/18/2010
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