NPIMap

Organization Active NPI

Teton County Hospital District

Doing business as St. John's Pharmacy

  • Community/Retail Pharmacy
  • Jackson, WY
National Provider Identifier
1952823783
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
R10167 Issued in WY
Legal business name
TETON COUNTY HOSPITAL DISTRICT
Doing business as
St. John's Pharmacy
Practice address
555 E Broadway Ave Ste 212
Jackson, WY 83001-8640
Phone
(307) 739-7656
Fax
(307) 739-7658
NPI assigned
Jul 13, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
TETON COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Alisa Lane
Title
Director of Finance
Phone
(307) 739-7641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X R10167 WY Primary

Addresses

Primary practice location

555 E Broadway Ave Ste 212
Jackson, WY 83001-8640

Mailing address

PO Box 428
Jackson, WY 83001-0428
Phone (307) 739-7656

Other identifiers 1

IdentifierTypeStateIssuer
R10167OtherWYSTATE LICENSE NUMBER

Other names 1

  • St. John's Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171212002833 WY Part B Supplier - Mass Immunization (Roster Biller Only) 4880582295 Practice locations: Jackson, WY

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
St Johns Hospital9 organizations share this tax ID, including this one
Part of
St Johns Hospital

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St Johns Med Center/Or St Johns HealthJackson, WY, CCN 530015 Hospital Other May 23, 2007
St Johns Medical CenterJackson, WY, CCN 53U015 Hospital Operational/Managerial Control Jun 13, 2014
St Johns Health Sage LivingJackson, WY, CCN 535046 Skilled nursing facility Adp of the SNF Mar 13, 2025
St. John's Home CareJackson, WY, CCN 537063 Home health agency Operational/Managerial Control (100%) Apr 27, 2010
St. John's HospiceJackson, WY, CCN 531504 Hospice Operational/Managerial Control (100%) Jan 1, 1970

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952823783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830010428",
            "telephone_number": "307-739-7656",
            "fax_number": "307-739-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE STE 212",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-739-7656",
            "fax_number": "307-739-7658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TETON COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2017-07-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "ALISA",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "307-739-7641"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WY",
            "license": "R10167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "R10167",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. John's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. John's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, WY

Sources for this page

Verify at the official NPI Registry.