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Organization
TETON RADIOLOGY DIAGNOSTIC, LLC
Active
Organization
TETON RADIOLOGY DIAGNOSTIC, LLC
Active
Parent organization
TETON RADIOLOGY DIAGNOSITC, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TETON RADIOLOGY DIAGNOSITC, LLC
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
—
—
Other
Enumeration date
04/27/2009
Last updated
01/05/2026
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