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CAH131313-02 Teton Valley Health Care, Inc. dba Teton Valley Hospital (Active)
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Main Details
Name
Teton Valley Health Care, Inc. dba Teton Valley Hospital
Subdivision Name
Victor Medical Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131313-02
Medicare Provider Number
131313
Outpatient Facility Provider Number
138510
Additional Details
Current Program Status
Active
Registration Date
1/13/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/14/2025
Last Recertification Date
Contacts
Authorizing Official
Teton Valley Health
Troy Christensen, CEO
(208) 354-6340
Primary Contact
Teton Valley health
Cassidy Howarth, DOP
(208) 354-6316
Addresses
Street Address
83 North Main Street
Victor, ID 83455
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 7/1/2013, Termination 10/1/2024, Reinstatement 4/1/2025.
01/14/2025
May 2025
May 2025
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