Provider Demographics
NPI:1386009835
Name:TETON HEALTHCARE, INC.
Entity type:Organization
Organization Name:TETON HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-207-2726
Mailing Address - Street 1:63 W WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1656
Mailing Address - Country:US
Mailing Address - Phone:208-888-7877
Mailing Address - Fax:208-888-7987
Practice Address - Street 1:63 W WILLOWBROOK DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1656
Practice Address - Country:US
Practice Address - Phone:208-888-7877
Practice Address - Fax:208-888-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20008402Medicare PIN