NPI age
19 years
Enumerated 2007-04-23
● Active Type 2 · Organization
Teton Plastic Surgery
Teton Plastic Surgery is 1 of 24 surgery organizations in Idaho.
Primary specialty
Surgery
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Martin
Office Manager
Last NPPES update
2023-03-07
Source: monthly bulk 2026-05
How this organization compares
Across 24 active surgery providers in Idaho.
NPI age
19 years
≈ at median (18 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2007 → 2026
2007-04Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
2860 Channing Way, Suite 213
Idaho Falls, ID 834047531
Mailing address
Po Box 1769
Idaho Falls, ID 834031769
Authorized official
Jennifer Martin
Office Manager
📞 2085521406
Individual providers at this organization
9 individual providers on file at this primary practice address.
- Charles Boge, MD Orthopaedic Surgery NPI 1831299148
- Emily Cowles, R.D.,L.D. Dietitian, Registered NPI 1205125259
- Boyd Hammond, MEDICAL DOCTOR Surgery NPI 1871689844
- Shannon Jenkins, DO Pediatrics NPI 1023083680
- Michael Moore, M.D., P.C. Surgery NPI 1306064860
- Brian O'Byrne, MD Surgery NPI 1801896717
- Brandi Smith, APRN-CNP Nurse Practitioner NPI 1114447406
- Sarah Vlach, MD Physical Medicine & Rehabilitation NPI 1326002221
- William Wilson, M.D. Plastic Surgery NPI 1447368758
Specialties
-
Surgery PrimaryA surgeon who specializes in plastic and reconstructive surgery.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | M-8270 | ID MEDICAL LICENSE |
| 01 (UT) | 5959620-1205 | UT MEDICAL LICENSE |
| 01 (UT) | 5959620-8905 | UT ST BOARD OF PHARMACY |
| 01 (WY) | 6687A | WY MEDICAL LICENSE |
| 01 (ID) | CS9201 | ID ST BOARD OF PHARMACY |
| 01 (WY) | 58MKM02 | WY ST BOARD OF PHARMACY |
| 01 (ID) | 04232007480947 | DR.MOORE NPI TRCKNG# |
Practice context
Multi-provider organization. 9 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.