Teton Radiology Diagnostic A Series Of Teton Group Enterprise
Radiology, Body Imaging in Idaho Falls, ID. Organization (NPI-2).
NPI number1013085604
StatusActive
Last updated in NPPESOct 19, 2026
Details
- NPI
- 1013085604
- Entity type
- Organization (NPI-2)
- Legal business name
- Teton Radiology Diagnostic A Series Of Teton Group Enterprise
- Organization subpart
- No
- Enumeration date
- Dec 1, 2006
- Certification date
- Oct 19, 2026
- Last updated
- Oct 19, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085B0100X | Radiology, Body Imaging | – | – | Yes |
| 2085N0700X | – | – | ||
| 2085N0904X | – | – | ||
| 2085P0229X | Radiology, Pediatric Radiology | – | – | |
| 2085R0001X | – | – | ||
| 2085R0202X | Radiology, Diagnostic Radiology | – | – | |
| 2085R0203X | Radiology, Therapeutic Radiology | – | – | |
| 2085R0204X | Radiology, Vascular & Interventional Radiology | – | – | |
| 2085R0205X | Radiology, Radiological Physics | – | – | |
| 2085U0001X | Radiology, Diagnostic Ultrasound | – | – |
Other names
- Teton Radiology (Doing Business As)
- Teton Radiology Diagnostic LLC (Doing Business As)
Practice location
2001 S Woodruff Ave Ste 17Idaho Falls, ID 83404-6372
Phone 208-524-7237
Mailing address
Po Box 30015Dept 594
Salt Lake City, UT 84130-0015
Phone 800-475-6236 · Fax 706-596-6712
Authorized official
Michael P Hodel
General Manager
2085425000
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