Teton Plastic Surgery

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

M-8270 Issued in ID

Legal business name

TETON PLASTIC SURGERY

Practice address

2860 Channing Way
Suite 213
Idaho Falls, ID 83404-7531

Phone

(208) 552-1406

Fax

(208) 552-1416

NPI assigned

Apr 23, 2007

Organization subpart

No

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

Authorized official

Name

Jennifer Martin

Title

Office Manager

Phone

(208) 552-1406

Specialties & licenses 1

Addresses

Other identifiers 7

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Kirk Moore Jr., M.D., P.C.

  • Plastic and Reconstructive Surgery Physician
  • Idaho Falls, ID
  • NPI 1306064860
  NPD (past)

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1154549616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1769",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834031769",
            "telephone_number": "208-552-1406",
            "fax_number": "208-552-1416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2860 CHANNING WAY",
            "address_2": "SUITE 213",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047531",
            "telephone_number": "208-552-1406",
            "fax_number": "208-552-1416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON PLASTIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-552-1406"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "ID",
            "license": "M-8270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ID MEDICAL LICENSE",
            "identifier": "M-8270",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UT MEDICAL LICENSE",
            "identifier": "5959620-1205",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UT ST BOARD OF PHARMACY",
            "identifier": "5959620-8905",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WY MEDICAL LICENSE",
            "identifier": "6687A",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ID ST BOARD OF PHARMACY",
            "identifier": "CS9201",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WY ST BOARD OF PHARMACY",
            "identifier": "58MKM02",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR.MOORE NPI TRCKNG#",
            "identifier": "04232007480947",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teton Nuclear Medicine Service LLC
• Teton Obstetrics and Gynecology PA
• Teton Oms (Snake River Surgical)
• Teton Outpatient, LLC
• Teton Physical Therapy, Inc
• Teton Radiology Diagnostic a Series of Teton Group Enterprise (Teton Radiology)
• Teton Radiology Diagnostic, LLC
• Teton Surgical Specialties PLLC (Teton Hand Surgery)
• Teton Women's Health Center
• Alisha Michelle Tew, CMA, CNA, PA

• Plastic and Reconstructive Surgery Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Plastic and Reconstructive Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.