NPIMap

Organization Active NPI

Teton Valley Health Care, Inc

Doing business as Teton Valley Health Care Swing Bed Unit

  • Medicare Defined Swing Bed Hospital Unit
  • Driggs, ID
National Provider Identifier
1053669598
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
31 Issued in ID
Legal business name
TETON VALLEY HEALTH CARE, INC
Doing business as
Teton Valley Health Care Swing Bed Unit
Practice address
120 E Howard Avenue
Driggs, ID 83422-5112
Phone
(208) 354-2383
Fax
(208) 354-3158
NPI assigned
Aug 15, 2012
Last updated
Feb 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jill Payne
Title
Chief of Compliance
Phone
(208) 354-6302

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 31 ID Primary
Critical Access Hospital 282NC0060X 31 ID
Ambulance 341600000X 31 ID

Addresses

Primary practice location

120 E Howard Avenue
Driggs, ID 83422-5112

Mailing address

120 E Howard Avenue
Driggs, ID 83422-5112
Phone (208) 354-2383

Other names 1

  • Teton Valley Health Care Swing Bed Unit Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220802004129 ID Part A Provider - Critical Access Hospital 3870744956 Practice locations: Driggs, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053669598. Details of each certification follow.

Hospital certification: CCN 13Z313

Legal name
TETON VALLEY HEALTH CARE INC
Doing business as
TETON VALLEY HOSPITAL SWING BED UNIT
Organization structure
CorporationNon-profit
Incorporated
Jan 11, 2012 in ID
Enrollment address
120 East Howard Avenue
Driggs, ID 83422-5112
Hospital Swing-Bed Unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

285 E Little Ave
Driggs, ID 83422
Phone (208) 354-1999

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lori Leianne Everett Individual Corporate OfficerCfo Dec 15, 2023
Ken Dunn Individual Corporate Director Feb 16, 2024
Gene Marcowka Individual Corporate Director Feb 16, 2024
Joseph Troy Christensen Individual Corporate OfficerCeo Aug 29, 2023
W-2 Managing EmployeeCeo Aug 29, 2023
Anjali S Tate Individual Corporate Director Feb 16, 2024
Jo Anne Kay Individual Corporate Director Feb 16, 2024
Lisa Loughran Individual Corporate OfficerCoo/Cno Jun 6, 2022

Practitioners & affiliated clinicians

Practitioners 84

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 84

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1053669598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 E HOWARD AVENUE",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "834225112",
            "telephone_number": "208-354-2383",
            "fax_number": "208-354-3158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E HOWARD AVENUE",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "834225112",
            "telephone_number": "208-354-2383",
            "fax_number": "208-354-3158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON VALLEY HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-15",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "CHIEF OF COMPLIANCE",
        "authorized_official_telephone_number": "208-354-6302",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "ID",
            "license": "31",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "ID",
            "license": "31",
            "primary": false
        },
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "ID",
            "license": "31",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teton Valley Health Care Swing Bed Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Teton Valley Health Care Swing Bed Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Driggs, ID

Sources for this page

Verify at the official NPI Registry.