NPI age
20 years
Enumerated 2005-06-14
● Active Type 2 · Organization
Grand Teton Surgical Center Llc
Grand Teton Surgical Center Llc is 1 of 99 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Wellard
Director Of Nursing
Last NPPES update
2010-03-02
Source: monthly bulk 2026-05
How this organization compares
Across 99 active clinic/center providers in Idaho.
NPI age
20 years
↑ 2 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2005 → 2026
2005-06Enumerated in NPPES
2005
2026
Where they practice
Primary practice location
2290 Coronado St
Idaho Falls, ID 834047552
Mailing address
2290 Coronado St
Idaho Falls, ID 834047552
Authorized official
Teresa Wellard, R.N.
Director Of Nursing
📞 2085243800
Individual providers at this organization
1 individual provider on file at this primary practice address.
- David Swope, CRNA Nurse Anesthetist, Certified Registered NPI 1033470216
Specialties
-
Clinic/Center PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 03772 | BLUE CROSS |
| 01 (ID) | 000010005323 | REGENCE BLUE SHIELD |
| 05 (ID) | 805482600 |
Practice context
Multi-provider organization. 1 individual provider 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.