| Organization Name: | TETON RADIOLOGY DIAGNOSTIC LLC |
| NPI Number: | 1013085604 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL P HODEL (GENERAL MANAGER) |
| Mailing Address: | 2001 S Woodruff Ave Ste 17 Idaho Falls |
| State: | ID US |
| Postal Code: | 834046372 |
| Phone Number: | 2085247237 |
| Fax Number: | |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 05/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085N0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Neuroradiology |
| Taxonomy Definition: | A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children. |