institution
Grand Teton Surgical Center Llc
Ambulatory Surgical Clinic/Center in Idaho Falls, Idaho
NPI 1841295227

Grand Teton Surgical Center Llc is an Ambulatory Surgical Clinic/Center based in Idaho Falls, ID and is specialized in Ambulatory Surgical. Grand Teton Surgical Center Llc practices in Idaho Falls, ID. The NPI Number for Grand Teton Surgical Center Llc is 1841295227 and holds a License No. (Idaho).

The current practice location address for Grand Teton Surgical Center Llc is 2290 Coronado St, Idaho Falls, ID and can be reached out via phone at 208-524-3800 and via fax at 208-524-3805.

Location: 2290 Coronado St, Idaho Falls, ID, 83404-7552
institution
Provider Profile Details
NPI Number
1841295227
Provider Name
Grand Teton Surgical Center Llc
Credential
Provider Entity Type
Organization
Address
2290 Coronado St, Idaho Falls, ID, 83404-7552
Phone Number
208-524-3800
Fax Number
208-524-3805
Provider Enumeration Date
06/14/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
03772 01 ID BLUE CROSS
000010005323 01 ID REGENCE BLUE SHIELD
805482600 05 ID
institution
Provider Business Practice Location Address Details
Address
2290 Coronado St
City
State
Zip
83404-7552
Phone Number
208-524-3800
Fax Number
208-524-3805
person
Provider Business Mailing Address Details
Address
2290 Coronado St
City
State
Zip
83404-7552
Phone Number
208-524-3800
Fax Number
208-524-3805
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Ambulatory Surgical
Taxonomy
License No.
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Definition
Definition to come...
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