NPIMap

Organization Active NPI

Teton Cardiovascular and Pulmonary Lab,LLC

Doing business as Snake River Cardiovascular & Pulmonary Laboratory

  • Physiological Laboratory
  • Idaho Falls, ID
National Provider Identifier
1699784413
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
TETON CARDIOVASCULAR AND PULMONARY LAB,LLC
Doing business as
Snake River Cardiovascular & Pulmonary Laboratory
Practice address
2001 S Woodruff Ave
Suite 12 B
Idaho Falls, ID 83404-6374
Phone
(800) 341-1043
Fax
(208) 528-7971
NPI assigned
Aug 8, 2006
Last updated
May 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Authorized official

Name
Braden L Cazares
Title
Ceo
Phone
(972) 677-3896

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X NU Primary

Addresses

Primary practice location

2001 S Woodruff Ave
Suite 12 B
Idaho Falls, ID 83404-6374

Mailing address

PO Box 2559
Burleson, TX 76097-2559
Phone (800) 341-1043

Other identifiers 3

IdentifierTypeStateIssuer
000010153937OtherIDBLUE SHIELD OF IDAHO
807391800MedicaidID
8M795OtherIDBLUE CROSS OF IDAHO

Other names 1

  • Snake River Cardiovascular & Pulmonary Laboratory Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050908001155 ID Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1355373481 Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Locations

2001 S Woodruff Ave
Ste 12B
Idaho Falls, ID 83404
Phone (208) 529-2498

3302 Valencia Dr
Ste 202
Idaho Falls, ID 83404
Phone (208) 529-2498

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746489600000",
    "number": "1699784413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2559",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760972559",
            "telephone_number": "800-341-1043",
            "fax_number": "208-528-7971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE",
            "address_2": "SUITE 12 B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046374",
            "telephone_number": "800-341-1043",
            "fax_number": "208-528-7971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON CARDIOVASCULAR AND PULMONARY LAB,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A",
        "authorized_official_last_name": "CAZARES",
        "authorized_official_first_name": "BRADEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "972-677-3896"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF  IDAHO",
            "identifier": "000010153937",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807391800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "8M795",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Snake River Cardiovascular & Pulmonary Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.