Active NPI
Teton Valley Hospital & Surgicenter
- Family Medicine Physician
- Driggs, ID
National Provider Identifier
1780625632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 31
- Legal business name
- TETON VALLEY HOSPITAL & SURGICENTER
- Doing business as
- Driggs Health Clinic
- Practice address
- 283 N 1St Street
Driggs, ID 83422-5112 - Phone
- (208) 354-2302
- Fax
- (208) 354-8392
- NPI assigned
- Jun 10, 2006
- Organization subpart
- Yes
- Parent organization
- TETON VALLEY HOSPITAL & SURGICENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Laura C Piquet
- Title
- Operations Manager
- Phone
- (208) 354-6302
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 31 | ID | |
| Family Medicine Physician | 207Q00000X | 31 | ID | Primary |
| Orthopaedic Surgery Physician | 207X00000X | 31 | ID | |
| Pediatrics Physician | 208000000X | 31 | ID | |
| Surgery Physician | 208600000X | 31 | ID | |
| Urology Physician | 208800000X | 31 | ID | |
| Interventional Pain Medicine Physician | 208VP0014X | 31 | ID |
Addresses
Primary practice location
283 N 1St Street
Driggs, ID 83422-5112
Mailing address
120 East Howard Avenue
Driggs, ID 83422-5112
Phone (208) 354-2302
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010159438 | Other | ID | REGENCE BLUE SHIELD |
| 807736200 | Medicaid | ID | |
| 8M953 | Other | ID | BLUE CROSS |
| 9122702-00 | Medicaid | FL |
Other names 1
- Driggs Health Clinic
National Provider Directory
National Provider Directory- Part of
- Teton Valley Hospital Surgicenter
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Sports Medicine (Family Medicine) Physician
- Reno, NV
- NPI 1902905813
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1351468800000",
"number": "1780625632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 EAST HOWARD AVENUE",
"city": "DRIGGS",
"state": "ID",
"postal_code": "834225112",
"telephone_number": "208-354-2302",
"fax_number": "208-354-8392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "283 N 1ST STREET",
"city": "DRIGGS",
"state": "ID",
"postal_code": "834225112",
"telephone_number": "208-354-2302",
"fax_number": "208-354-8392"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TETON VALLEY HOSPITAL & SURGICENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TETON VALLEY HOSPITAL & SURGICENTER",
"enumeration_date": "2006-06-10",
"last_updated": "2012-10-29",
"status": "A",
"authorized_official_last_name": "PIQUET",
"authorized_official_first_name": "LAURA",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OPERATIONS MANAGER",
"authorized_official_telephone_number": "208-354-6302",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "31",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "ID",
"license": "31",
"primary": true
},
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": "ID",
"license": "31",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "ID",
"license": "31",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": "ID",
"license": "31",
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Urology",
"state": "ID",
"license": "31",
"primary": false
},
{
"code": "208VP0014X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "ID",
"license": "31",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "000010159438",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807736200",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "8M953",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9122702-00",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Driggs Health Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Driggs, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.