Provider Demographics
NPI:1215064985
Name:TETON COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:TETON COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-739-7526
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-0428
Mailing Address - Country:US
Mailing Address - Phone:307-739-7450
Mailing Address - Fax:307-739-7344
Practice Address - Street 1:625 E BROADWAY AVE BLDG B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8642
Practice Address - Country:US
Practice Address - Phone:307-739-7450
Practice Address - Fax:307-739-7344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TETON COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
WY0713132314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106299901Medicaid
WY535046Medicare PIN