Teton Hearing Center LLC

Primary specialty

AudiologistTaxonomy code 231H00000X

License

A-974 Issued in WY

Legal business name

TETON HEARING CENTER LLC

Practice address

50 Ski Hill Rd.
Driggs, ID 83422

Phone

(208) 569-8787

Fax

(208) 354-2656

NPI assigned

Oct 22, 2008

Last updated

Oct 22, 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

Eliza S. Petersen, M.A. CCC-A FAAANPI 1083750996

Title

Manager/Member/Audiologist

Phone

(208) 569-8787

Specialties & licenses 4

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.

• Eliza S. Petersen, AUD, CCCA

  • Audiologist
  • Driggs, ID
  • NPI 1083750996
  NPD (past) Authorized official

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

{
    "created_epoch": "1224633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224633600000",
    "number": "1659523694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 692",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "83422",
            "telephone_number": "208-569-8787",
            "fax_number": "208-354-2656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 SKI HILL RD.",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "83422",
            "telephone_number": "208-569-8787",
            "fax_number": "208-354-2656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON HEARING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-22",
        "last_updated": "2008-10-22",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "ELIZA",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "MANAGER/MEMBER/AUDIOLOGIST",
        "authorized_official_telephone_number": "208-569-8787",
        "authorized_official_credential": "M.A.  CCC-A  FAAA"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "ID",
            "license": "AUD1142",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WY",
            "license": "A-974",
            "primary": true
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "WY",
            "license": "A-974",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "ID",
            "license": "AUD1142",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807694600",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125563100",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Missy Renee Sturk, M.S., OTR/L
• Brenna Taow
• Teton County Fire Protection Dist (Teton County Fire & Rescue)
• Teton County Fire Protection District
• Teton County Hospital District (St. John's Four Peaks Clinic)
• Teton Psychological Services, Inc.
• Teton River Pediatrics
• Teton School District #401
• Teton Valley Counseling
• Teton Valley Counseling, Inc

• Audiologist in Driggs, ID
• Providers in Driggs, ID by specialty
• Audiologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.