| Teton Medical Group Pllc | |
|
32 W 1st S Rexburg ID 83440-1810 | |
| (208) 356-7585 | |
| (208) 356-7566 |
| Full Name | Teton Medical Group Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 32 W 1st S, Rexburg, Idaho |
| Authorized Official Name and Position | Richard Thomas Jones (OWNER) |
| Authorized Official Contact | 2083567585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Teton Medical Group Pllc 32 West 1st South Rexburg ID 83440-1810 Ph: (208) 356-7585 | Teton Medical Group Pllc 32 W 1st S Rexburg ID 83440-1810 Ph: (208) 356-7585 |
| NPI Number | 1154502615 |
|---|---|
| Provider Enumeration Date | 11/26/2007 |
| Last Update Date | 07/16/2008 |
| Medicare PECOS PAC ID | 1759470172 |
|---|---|
| Medicare Enrollment ID | O20071207000402 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154502615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M-10078 (Idaho) | Primary |
| Provider Name | Richard T Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346341021 PECOS PAC ID: 2769489939 Enrollment ID: I20071207000371 |
| Provider Name | Jamie L Gudmunson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669853719 PECOS PAC ID: 3971816448 Enrollment ID: I20150714000351 |
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