TETON PLASTIC SURGERY (NPI# 1154549616) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154549616 |
| Entity Type | Organization |
| Organization Name | TETON PLASTIC SURGERY |
| Practice Address |
2860 Channing Way Suite 213 Idaho Falls ID 83404-7531 |
| Mailing Address |
Po Box 1769 Idaho Falls ID 83403-1769 |
| Practice Telephone | 2085521406 |
| Practice Fax Number | 2085521416 |
| Mailing Telephone | 2085521406 |
| Mailing Fax Number | 2085521416 |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JENNIFER MARTIN (OFFICE MANAGER) |
| Authorized Official Telephone | 2085521406 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
M-8270 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | ID ST BOARD OF PHARMACY | CS9201 | 01 |
| UT | UT MEDICAL LICENSE | 5959620-1205 | 01 |
| WY | WY ST BOARD OF PHARMACY | 58MKM02 | 01 |
| WY | WY MEDICAL LICENSE | 6687A | 01 |
| ID | DEA | BM4151849 | 01 |
| ID | ID MEDICAL LICENSE | M-8270 | 01 |
| UT | UT ST BOARD OF PHARMACY | 5959620-8905 | 01 |
| ID | DR.MOORE NPI TRCKNG# | 04232007480947 | 01 |
| Street Address |
2860 CHANNING WAY SUITE 213 |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404-7531 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801896717 | Brian E O'byrne | Surgery | 2860 Channing Way, Ste 117, Idaho Falls, ID 83404-7532 | 2005-07-21 |
| 1114447406 | Brandi Jo Smith | Nurse Practitioner | 2860 Channing Way, Suite 115, Idaho Falls, ID 83404 | 2017-06-27 |
| 1801288782 | Rocky Mountain Holdings, LLC | Ambulance | 2860 Channing Way, #206, Idaho Falls, ID 83404 | 2015-03-02 |
| 1831435163 | Idaho Behavioral Health Services, LLC | Psychiatry & Neurology | 2860 Channing Way, #100, Idaho Falls, ID 83404 | 2012-12-13 |
| 1679818025 | Eastern Idaho Regional Medical Center Inpatient Services, LLC | Internal Medicine | 2860 Channing Way, Suite 100, Idaho Falls, ID 83404-7531 | 2012-12-11 |
| 1013271899 | Joseph Murdock Strobel | Internal Medicine | 2860 Channing Way, Suite 213, Idaho Falls, ID 83404-7541 | 2012-06-27 |
| 1205125259 | Emily Ann Cowles | Dietitian, Registered | 2860 Channing Way, Suite 115, Idaho Falls, ID 83404-7531 | 2011-03-30 |
| 1376858878 | East Falls Cardiovascular and Thoracic Surgery, LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2860 Channing Way, Ste 112, Idaho Falls, ID 83404-7532 | 2010-08-10 |
| 1104065861 | R.k. Arbon, M.d., P.a. | Family Medicine | 2860 Channing Way, Suite 116, Idaho Falls, ID 83404-7531 | 2009-02-19 |
| 1023267895 | East Falls Plastic Surgery LLC | Plastic Surgery | 2860 Channing Way, Suite 114a, Idaho Falls, ID 83404-7531 | 2008-09-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1942863600 | Muhammad Arslan Khan | Student in an Organized Health Care Education/Training Program | 2860 Channing Way Suite 214, Idaho Falls, ID 83404 | 2019-04-18 |
| 1942771043 | Physician's Choice Cardiology, Pllc | Internal Medicine | 3302 Valencia, Suite 201, Idaho Falls, ID 83404 | 2018-12-16 |
| 1609358761 | Cardiac Cath Lab of Idaho Falls | Internal Medicine | 3311 Valencia Drive, Idaho Falls, ID 83404 | 2018-09-05 |
| 1083196380 | Hannah Golden | Occupational Therapist | 1460 Elk Creek, Idaho Falls, ID 83404 | 2018-09-04 |
| 1316423049 | Lindsay Sessions | Speech-Language Pathologist | 2210 Niagara St, Idaho Falls, ID 83404 | 2018-07-16 |
| 1720574023 | Bmh, Inc. | Anesthesiology | 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 | 2018-07-10 |
| 1093237935 | Jason Earl Bailey | Contractor | 3100 S Woodruff Ave., Idaho Falls, ID 83404 | 2017-07-12 |
| 1235682121 | Mountain Falls Quick Care | Clinic/Center | 1995 E 17th St #1, Idaho Falls, ID 83404 | 2016-07-27 |
| Find all providers in zip 83404 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912046210 | Center for Aesthetics PC | Surgery | 2375 E Sunnyside Road, Suite G, Idaho Falls, ID 83404 | 2007-02-05 |
| 1306064860 | Michael Kirk Moore Jr. | Surgery | 2860 Channing Way, Suite 213, Idaho Falls, ID 83404-7531 | 2007-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427523968 | Q17 Health Partners LLC | Surgery | 100 East Idaho Street #317, Boise, ID 83712 | 2018-10-11 |
| 1588877641 | John Arthur Jarrell Iv | Surgery | 3090 E Gentry Way Ste 210, Meridian, ID 83642-3550 | 2007-05-07 |
| 1265656268 | David William Becker Jr. | Surgery | 668 Ballingrude Dr, Twin Falls, ID 83301-4403 | 2007-04-12 |
| 1073668042 | Thomas Floyd Crais Jr. | Surgery | 315 S River St, Hailey, ID 83333-8426 | 2007-01-23 |
| 1003823956 | Craig B. Bass | Surgery | 250 Bobwhite Ct, # 275, Boise, ID 83706-6643 | 2006-08-02 |
| 1427086164 | Mark David Wigod | Surgery | 3630 E Louise Drive, Meridian, ID 83642 | 2006-06-29 |
| 1629069885 | Patrick James Mullen | Surgery | 2121 W Ironwood Center Dr, Coeur D Alene, ID 83814-2639 | 2005-11-04 |
| 1477195931 | Jarrell Plastic Surgery | Surgery | 3090 E Gentry Way Ste 210, Meridian, ID 83642-3550 | 2019-10-16 |
| 1720381536 | Patrick J Mullen Md Pllc | Surgery | 750 N Syringa St, Suite 204, Post Falls, ID 83854-5275 | 2010-12-16 |
| 1073757464 | Michael R Dibenedetto Md Pllc | Surgery | 30544 Highway 200, Suite 102, Ponderay, ID 83852-5005 | 2009-04-29 |
| Find all providers with the same taxonomy | ||||
| City | IDAHO FALLS |
| Zip Code | 83404 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.