Teton Valley Health Care Inc
Organization Active NPI Rural Health Clinic/Center · Driggs, ID
NPI 1013264183 · NPPES record last updated Feb 20, 2020
Key facts
- NPI
- 1013264183
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 31 (ID)
- Legal business name
- TETON VALLEY HEALTH CARE INC
- Practice address
- 283 N 1St E
Driggs, ID 83422-5109 - Phone
- (208) 354-2302
- Fax
- (208) 354-8392
- NPI assigned
- Aug 8, 2012
- Organization subpart
- No
Authorized official
- Name
- Jill Payne
- Title
- Chief of Compliance
- Phone
- (208) 354-6352
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 3
Related certifications (CCN) 1
Practitioners 97
-
Ann E Alton, DPT
-
Kristen Coburn, FNP/C
-
Robert Crouch, DO
-
Anna McCamy Gunderson, PA-C
-
Michael Ray Haskell, PA-C
-
Andrew Mayer, DPT
-
Brandon Lynn Miner, D.O
-
Hyrum Bert Prestwich, FNP-C
-
Daniel N Streubel, MPT
-
Gregory Michael Behm, M.D.
-
Joshua Clutter, M.D.
-
Katie Jean Houmes, M.D.
-
Marcel Robert Lak, D.P.T.
-
Luke A Martin, M.D.
-
William E Nibley, M.D.
-
David J Tomchak, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID
Rural health clinic certification: CCN 138511
- Legal name
- TETON VALLEY HEALTH CARE INC
- Doing business as
- DRIGGS CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 1, 2007
- Last certification
- Feb 13, 2003
- Ownership / control type
- Non-profit – church related
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 11, 2012 in ID
- Enrollment address
- 283 N 1St E
Driggs, ID 83422-5109 - Related CCNs
- 131313
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Lori Leianne Everett |
Corporate Officer |
Dec 15, 2023 | |
| W-2 Managing Employee |
Sep 25, 2025 | ||
| Ken Dunn |
Corporate Director | Feb 16, 2024 | |
| Gene Marcowka |
Corporate Director | Feb 16, 2024 | |
| Anjali S Tate |
Corporate Director | Feb 16, 2024 | |
| Nathan Levanger |
W-2 Managing Employee |
Apr 1, 2025 | |
| Jill Payne |
W-2 Managing Employee |
Mar 5, 2024 | |
| Jo Anne Kay |
Corporate Director | Feb 16, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121120000517 | ID | Part a Provider - Rural Health Clinic | 3870744956 | Practice locations: Driggs, ID |
| O20121128000587 | ID | Part B Supplier - Clinic/Group Practice | 3870744956 |
Receives reassigned benefits from 94 practitioners 2 other NPIs on this enrollment Practice locations: Driggs, ID; Victor, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician |
207LP2900X | |||
| Family Medicine Physician |
207Q00000X | ID | ||
| Ophthalmology Physician |
207W00000X | ID | ||
| Orthopaedic Surgery Physician |
207X00000X | ID | ||
| Sports Medicine (Orthopaedic Surgery) Physician |
207XX0005X | ID | ||
| Otolaryngology Physician |
207Y00000X | ID | ||
| Surgery Physician |
208600000X | ID | ||
| Interventional Pain Medicine Physician |
208VP0014X | ID | ||
| Rural Health Clinic/Center | 261QR1300X | 31 | ID | Yes |
| Medical Physician Assistant |
363AM0700X | ID | ||
| Family Nurse Practitioner |
363LF0000X | ID | ||
| Pediatric Nurse Practitioner |
363LP0200X | ID |
Addresses
Primary practice location
283 N 1St E
Driggs, ID 83422-5109
Mailing address
120 E Howard St
Driggs, ID 83422-5112
Phone (208) 354-6302
Other names
- Driggs Clinic
Other providers in Driggs, ID
- Teton Valley Counseling, Inc
- Teton Valley Counseling, Inc
- Teton Valley Counseling, Inc.
- Teton Valley Dental Center PLLC
- Teton Valley Dental Center PLLC
- Teton Valley Health Care Inc
- Teton Valley Health Care Inc
- Teton Valley Health Care, Inc
- Teton Valley Health Care, Inc
- Teton Valley Healthcare, Inc
All providers in Driggs, ID · Rural Health Clinic/Center in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.