Teton Oncology LLC

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

M8118 Issued in ID

Legal business name

TETON ONCOLOGY LLC

Practice address

380 Walker Dr
Rexburg, ID 83440-1657

Phone

(208) 356-9559

Fax

(208) 356-6601

NPI assigned

Jan 16, 2007

Last updated

Mar 31, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dane J Dickson, MDNPI 1669497194

Title

Owner Doctor

Phone

(208) 356-9559

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

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.

• Dane J Dickson, MD

  • Hematology & Oncology Physician
  • Rexburg, ID
  • NPI 1669497194
  Authorized official Same address or phone

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206921600000",
    "number": "1245382985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 WALKER DR",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401657",
            "telephone_number": "208-356-9559",
            "fax_number": "208-356-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 WALKER DR",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401657",
            "telephone_number": "208-356-9559",
            "fax_number": "208-356-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON ONCOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2008-03-31",
        "status": "A",
        "authorized_official_last_name": "DICKSON",
        "authorized_official_first_name": "DANE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "208-356-9559",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "ID",
            "license": "M8118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8J950",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010032448",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Tanner, LCSW
• Targhee Internal Medicine
• Randon Taylor, NMD
• Teton Cancer Institute
• Teton Medical Group PLLC
• Teton Radiology Madison LLC
• The Aspen Group, Inc. (Rexburg Home Health and Hospice)
• The Pediatric Place
• The Physical Therapy and Sportsmedicine Clinic Inc
• Therasense, LLC

• Hematology & Oncology Physician in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Hematology & Oncology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; 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.