MEDICARE: TETON RADIOLOGY CALDWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician
2	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1336920420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TETON RADIOLOGY CALDWELL

Provider Business Mailing Address
First Line	:	PO BOX 30015
Second Line	:	DEPT 598
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0015
Country	:	US
Telephone Number	:	800-475-6236
Fax Number	:	706-596-6712

Provider Business Practice Location Address
First Line	:	4519 ENTERPRISE WAY
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-8055
Country	:	US
Telephone Number	:	208-454-0742
Fax Number	:	208-455-7538

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN J STROBEL
Credential	:	MD
Telephone Number	:	208-542-5000

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	01/05/2026

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