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Contact Information

TETON CARDIOVASCULAR AND PULMONARY LAB,LLC
2001 S WOODRUFF AVE
SUITE 12 B
IDAHO FALLS, ID83404-6374
 Phone: 800-341-1043
 Fax: 208-528-7971
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physiological Laboratory, (Independent Physiological Lab)

293D00000X 47 Independent Diagnostic Testing Facility (IDTF)
Indicates primary specialty

NPI Profile & details for TETON CARDIOVASCULAR AND PULMONARY LAB,LLC

NPI Number 1699784413
LBN Legal business name TETON CARDIOVASCULAR AND PULMONARY LAB,LLC
Authorized official BRADEN CAZARES - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 08/08/2006
Last updated 05/06/2025 - More than a year ago
Identifiers
ID Medicaid 807391800
ID Other 8M795 BLUE CROSS OF IDAHO
ID Other 000010153937 BLUE SHIELD OF IDAHO
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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