National Provider Identifier Database

TETON RADIOLOGY DIAGNOSTIC A SERIES OF TETON GROUP ENTERPRISE
Body Imaging

A Radiology doctor of Osteopathy that specializes in Body Imaging.

Contact Information

TETON RADIOLOGY DIAGNOSTIC A SERIES OF TETON GROUP ENTERPRISE
2001 S WOODRUFF AVE STE 17
IDAHO FALLS, ID  83404-6372
Phone: 208-524-7237
Fax:
Website:
Specialty Taxonomy Code
* Body Imaging 2085B0100X
Diagnostic Radiology 2085R0202X
Diagnostic Ultrasound 2085U0001X
Neuroradiology 2085N0700X
Nuclear Radiology 2085N0904X
Pediatric Radiology 2085P0229X
Radiation Oncology 2085R0001X
Radiation Oncology 2085R0203X
Radiological Physics 2085R0205X
Vascular & Interventional Radiology 2085R0204X

* Indicates primary specialty

NPI Profile & details for TETON RADIOLOGY DIAGNOSTIC A SERIES OF TETON GROUP ENTERPRISE

NPI Number 1013085604
Legal business name
LBN		 TETON RADIOLOGY DIAGNOSTIC A SERIES OF TETON GROUP ENTERPRISE
Authorized official MICHAEL HODEL - (GENERAL MANAGER)
Entity Organization
Organization subpart No
Enumeration date 12/01/2006
Last updated 01/05/2026 - About 5 months ago
Sole proprietor1 Not specified
Identifiers
  • ID Medicaid: 807617900
  • Other: DF6608 RAILROAD MEDICARE

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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