| Grand Teton Child Neurology | |
|
2225 Teton Plz Ste B Idaho Falls ID 83404-6494 | |
| (208) 529-4300 | |
| (208) 529-1627 |
| Full Name | Grand Teton Child Neurology |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2225 Teton Plz Ste B, Idaho Falls, Idaho |
| Authorized Official Name and Position | Peter W Castellanos (NEUROLOGIST) |
| Authorized Official Contact | 2085294300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Teton Child Neurology 2225 Teton Plz Ste B Idaho Falls ID 83404-6494 Ph: (208) 529-4300 | Grand Teton Child Neurology 2225 Teton Plz Ste B Idaho Falls ID 83404-6494 Ph: (208) 529-4300 |
| NPI Number | 1639322258 |
|---|---|
| Provider Enumeration Date | 10/28/2008 |
| Last Update Date | 08/17/2021 |
| Certification Date | 08/17/2021 |
| Medicare PECOS PAC ID | 4789972795 |
|---|---|
| Medicare Enrollment ID | O20161006001848 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639322258 | NPI | - | NPPES |
| 77234 | Other | ID | BLUE CROSS OF IDAHO |
| 807968700 | Medicaid | ID |
| Provider Name | Peter W Castellanos |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811991474 PECOS PAC ID: 9133377252 Enrollment ID: I20120914000545 |
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