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TETON MEDICAL GROUP PLLC NPI 1154502615


NPI Information

NPI: 1154502615
Provider Name: TETON MEDICAL GROUP PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 13D1076682

Address:
32 W 1ST S
REXBURG, ID
ZIP 83440
Phone: (208) 356-7585
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TETON MEDICAL GROUP PLLC is a family medicine in Rexburg, ID. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. TETON MEDICAL GROUP PLLC NPI is 1154502615. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

32 W 1ST S
REXBURG, ID
ZIP 83440-810
Phone: (208) 356-7585
Fax: (208) 356-7566

The provider's authorized official is Richard Thomas Jones .
The authorized official title is Owner and has the following contact phone number (208) 356-7585.

The CLIA number assigned to this NPI record is 13D1076682 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/26/2007 and was last updated on 7/16/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineM-10078IDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
111001041MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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