Grand Teton Surgical Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GRAND TETON SURGICAL CENTER LLC

Practice address

2290 Coronado St
Idaho Falls, ID 83404-7552

Phone

(208) 524-3800

Fax

(208) 524-3805

NPI assigned

Jun 14, 2005

Last updated

Mar 2, 2010By 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

Teresa Wellard, R.N.

Title

Director of Nursing

Phone

(208) 524-3800

Specialties & licenses 1

Addresses

Other identifiers 3

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

CLIA laboratory certificates

Locations

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.

• Michael Scott Richins, D.O.

  • Gastroenterology Physician
  • Idaho Falls, ID
  • NPI 1497028609
  NPD (past)

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267488000000",
    "number": "1841295227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2290 CORONADO ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047552",
            "telephone_number": "208-524-3800",
            "fax_number": "208-524-3805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2290 CORONADO ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047552",
            "telephone_number": "208-524-3800",
            "fax_number": "208-524-3805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TETON SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2010-03-02",
        "status": "A",
        "authorized_official_last_name": "WELLARD",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "208-524-3800",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "03772",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010005323",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805482600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grand Teton Gastroenterology
• Grand Teton Gastroenterology, PA
• Grand Teton Service Group
• Grand Teton Service Group
• Grand Teton Service Group
• Alice Marie Gray, PSYD
• Patrick Greding, PT, DPT
• Kaitlyn Elizabeth Green, LMSW
• Paula Marie Green, LMSW
• Robert Greenig, PMHNP-BC

• Ambulatory Surgical Clinic/Center in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Ambulatory Surgical Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.