Graduated: 2019
NPI: 1194353268
Practice Locations (3)
INTENSIVE CARE CONSORTIUM INC
3100 CHANNING WAY
IDAHO FALLS, ID 834047533
2085296111
TETON COUNTY HOSPITAL DISTRICT
625 E BROADWAY AVE
JACKSON, WY 830018642
3077333636
SUBLETTE COUNTY HOSPITAL DISTRICT
625 E HENNICK ST
PINEDALE, WY 829415228
3073674133
Source: CMS National Downloadable File, September 2026.