Teton Outpatient Services LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0713016 Issued in WY

Legal business name

TETON OUTPATIENT SERVICES LLC

Practice address

150 Buffalo Way
Jackson, WY 83001-2530

Phone

(307) 733-8677

Fax

(307) 734-7365

NPI assigned

Dec 22, 2005

Last updated

Oct 24, 2024By 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

Eric Boon

Title

Officer/Authorized Official

Phone

(480) 567-0269

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Listed as

Teton Outpatient Services LLCCCN 53C0001010

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• Urology Associates Medical Group, PC

  • Urology Physician
  • Jackson, WY
  • NPI 1902982051

  Member Of

  NPD member
• Baylor University Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Dallas, TX
  • NPI 1518967231

  Member Of

  NPD member
• VHS San Antonio Partners LLC

  dba Baptist Health System

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1689651481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14201 DALLAS PKWY",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752542916",
            "telephone_number": "307-733-8677",
            "fax_number": "307-734-7365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 BUFFALO WAY",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830012530",
            "telephone_number": "307-733-8677",
            "fax_number": "307-734-7365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON OUTPATIENT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-22",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "480-567-0269"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WY",
            "license": "0713016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113599600",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490004244",
            "state": "WY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "2.16.840.1.113883.3.667.2",
            "affiliation": "Y",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Teton Hand Therapy LLC
• Teton Internal Medicine PC
• Teton MRI (MRI of Jackson Hole)
• Teton Oral & Maxillofacial Surgery
• Teton Oral and Maxillofacial Surgery
• Teton Pathology, PC
• Teton Pediatrics PC (Teton Pediatrics)
• Teton Psychology Clinic, LLC
• Teton Sports & Spine Imaging, LLC
• Teton Surgical Assist Services LLC

• Ambulatory Surgical Clinic/Center in Jackson, WY
• Providers in Jackson, WY by specialty
• Ambulatory Surgical Clinic/Center in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.