GRAND TETON MEDICAL CLINIC – NPI #1891997151
Clinic/Center

GRAND TETON MEDICAL CLINIC is an AHC clinic located in MORAN, WY. NPPES has assigned the NPI number 1891997151 to GRAND TETON MEDICAL CLINIC on May 31, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QU0200X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Urgent Care

The NPI profile was previously updated about 19 years ago on Aug 02, 2007. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for GRAND TETON MEDICAL CLINIC below.

NPI Profile for
GRAND TETON MEDICAL CLINIC

NPI Number
1891997151
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
GRAND TETON MEDICAL CLINIC
Primary location
INNER LOOP ROAD
JACKSON LAKE LODGE
MORAN, WY 83013
Phone: (307) 543-2514 Fax: (307) 543-2514
Mailing address
PO BOX 15240
JACKSON, WY 83002-5240
Phone: (307) 733-8002 Fax: (307) 733-0032
Organization Subpart
No
Authorized Official
BRENT BLUE
CLINIC OWNER
Phone: (307) 733-8002
Updated
Identifiers

Identifiers for GRAND TETON MEDICAL CLINIC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDWY1096516-00
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QU0200X
- Clinic/Center / Urgent Care (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.