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General NPI Number Information
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NPI Number | 1013085604
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Entity Type | Organization
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Legal Business Name | TETON RADIOLOGY DIAGNOSTIC A SERIES OF TETON GROUP ENTERPRISE
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 2001 S WOODRUFF AVE STE 17
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6372
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Country | US
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Telephone | 208-524-7237
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | IDAHO FALLS
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State | ID
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Zip | 83403-2147
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Country | US
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Telephone | 208-523-4906
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Fax | 208-523-2025
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. MICHAEL P HODEL
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Credential |
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Telephone | 208-542-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2085R0205X
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Taxonomy Name | Radiological Physics Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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