Grand Teton Child Neurology
LBN: Grand Teton Child Neurology
Grand Teton Child Neurology is an health care organization with primary practice located at 2225 Teton Plz Ste B , Idaho Falls ID 83404-6494. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology, Agencies / Community/Behavioral Health. Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology is the primary health care specialty.
Grand Teton Child Neurology can be contacted via phone (208) 529-4300, or through Castellanos, Peter W via phone (208) 529-4300.
Contact Information
Primary practice address
2225 Teton Plz Ste B
Idaho Falls ID 83404-6494
Phone: (208) 529-4300
Fax: (208) 529-1627
Website:
Authorized official contact:
Name: Castellanos, Peter W Doctor of Medicine (MD)
Phone: (208) 529-4300
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology | 2084N0402X | ||
| Agencies / Community/Behavioral Health | 251S00000X |
Profile Details
| NPI number | 1639322258 |
|---|---|
| LBN Legal business name | Grand Teton Child Neurology |
| DBA Doing business as | |
| Authorized official | Castellanos, Peter W Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 28th, 2008 |
| Last updated | Aug 17th, 2021 - about 3 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639322258 | NPPES |
| Idaho | Other | 77234 | BLUE CROSS OF IDAHO |
| Idaho | MEDICAID | 807968700 | BLUE CROSS OF IDAHO |
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