Teton Radiology Diagnostic, LLC
Radiology, Body Imaging in Idaho Falls, ID. Organization (NPI-2).
NPI number1194969725
StatusActive
Last updated in NPPESJan 5, 2026
Details
- NPI
- 1194969725
- Entity type
- Organization (NPI-2)
- Legal business name
- Teton Radiology Diagnostic, LLC
- Organization subpart
- Yes
- Enumeration date
- Apr 27, 2009
- Certification date
- Jan 5, 2026
- Last updated
- Jan 5, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085B0100X | Radiology, Body Imaging | – | – | Yes |
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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