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Organization
TETON RADIOLOGY DIAGNOSTIC A SERIES OF TETON GROUP ENTERPRISE
Active
Organization
TETON RADIOLOGY DIAGNOSTIC A SERIES OF TETON GROUP ENTERPRISE
Active
Other names
Teton Radiology, Teton Radiology Diagnostic LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL P HODEL (GENERAL MANAGER)
(208) 542-5000
Entity
Organization
Contact information
Practice address
2001 S WOODRUFF AVE STE 17, IDAHO FALLS, ID 83404-6372
(208) 524-7237
Mailing address
PO BOX 30015, DEPT 594, SALT LAKE CITY, UT 84130-0015
(800) 475-6236
(706) 596-6712
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
—
NULL
2085B0100X
Body Imaging Physician
Primary
—
—
2085N0700X
Neuroradiology Physician
—
NULL
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
NULL
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
NULL
2085P0229X
Pediatric Radiology Physician
—
—
2085R0001X
Radiation Oncology Physician
—
NULL
2085R0001X
Radiation Oncology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0203X
Therapeutic Radiology Physician
—
NULL
2085R0203X
Therapeutic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
NULL
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085R0205X
Radiological Physics Physician
—
NULL
2085R0205X
Radiological Physics Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
NULL
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807617900
—
ID
01
—
DF6608
RAILROAD MEDICARE
—
Enumeration date
12/01/2006
Last updated
01/05/2026
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