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General NPI Number Information
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NPI Number | 1427574987
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Entity Type | Organization
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Legal Business Name | TETON SPORTS & SPINE IMAGING, LLC
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 250 SCOTT LN STE 110
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City | JACKSON
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State | WY
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Zip | 83001-8060
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Country | US
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Telephone | 307-201-5380
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Fax | 307-201-5202
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Provider Business Mailing Address
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Address Line | PO BOX 736
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City | WHEAT RIDGE
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State | CO
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Zip | 80034-0736
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Country | US
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Telephone | 307-218-8225
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Fax | 307-218-8226
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Authorized Official
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Title or Position | MANAGER/PARTNER
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Name | SHAUN ANDRIKOPOULOS
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Credential |
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Telephone | 307-201-5380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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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 | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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