Grand Teton Gastroenterology, PA

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

GRAND TETON GASTROENTEROLOGY, PA

Practice address

2770 Cortez Ave
Idaho Falls, ID 83404-7590

Phone

(208) 522-4000

Fax

(208) 528-4242

NPI assigned

Mar 15, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Melissa Dawn Lemons, CCS-P

Title

Billing Supervisor

Phone

(208) 528-4255

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DIGESTIVE HEALTH CENTER Former legal business name

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275868800000",
    "number": "1154390938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2770 CORTEZ AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047590",
            "telephone_number": "208-522-4000",
            "fax_number": "208-528-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2770 CORTEZ AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047590",
            "telephone_number": "208-522-4000",
            "fax_number": "208-528-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TETON GASTROENTEROLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2010-06-07",
        "status": "A",
        "authorized_official_last_name": "LEMONS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "208-528-4255",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CCS-P"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002708500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIGESTIVE HEALTH CENTER",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Zebulon C Graham, PHARMD
• Grand Teton Child Neurology
• Grand Teton Chiropractic, P.C.
• Grand Teton Chiropractic, PLLC
• Grand Teton Gastroenterology
• Grand Teton Service Group
• Grand Teton Service Group
• Grand Teton Service Group
• Grand Teton Surgical Center LLC
• Alice Marie Gray, PSYD

• Gastroenterology Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Gastroenterology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.