Grand Teton Medical Clinic

LBN: Grand Teton Medical Clinic
Grand Teton Medical Clinic is an health care organization with primary practice located at Inner Loop Road Jackson Lake Lodge, Moran WY 83013. The organization recently has only one registered license in Ambulatory Health Care Facilities / Urgent Care, which is considered as the primary health care specialty. Grand Teton Medical Clinic can be contacted via phone (307) 543-2514, or through Blue, Brent via phone (307) 733-8002.

Contact Information

Primary practice address
Inner Loop Road Jackson Lake Lodge Moran WY 83013
Phone: (307) 543-2514
Fax: (307) 543-2514
Website:
Map and Directions
Authorized official contact:
Name: Blue, Brent Doctor of Medicine (MD)
Phone: (307) 733-8002

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Urgent Care 261QU0200X

Profile Details

NPI number 1891997151
LBN Legal business name Grand Teton Medical Clinic
DBA Doing business as
Authorized official Blue, Brent Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date May 31st, 2007
Last updated Aug 2nd, 2007 - about 18 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891997151 NPPES
Wyoming MEDICAID 1096516-00

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