| Organization Name: | TETON MRI OF IDAHO FALLS |
| NPI Number: | 1053305144 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BONNIE C. GRAY (ADMINISTRATIVE ASSISTANT) |
| Mailing Address: | 2060 S Woodruff Ave Idaho Falls |
| State: | ID US |
| Postal Code: | 834046396 |
| Phone Number: | 2085520828 |
| Fax Number: | 2085520829 |
| NPI Enumeration Date: | 09/06/2005 |
| NPI Last Update Date: | 07/10/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |