# TETON RADIOLOGY DIAGNOSTIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TETON RADIOLOGY DIAGNOSITC, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1194969725
- **Legal business name:** TETON RADIOLOGY DIAGNOSITC, LLC
- **Authorized official:** MR. MICHAEL P HODEL (GENERAL MANAGER)
- **Authorized official phone:** (208) 542-5000

## Contact information

- **Practice address:** 2001 S WOODRUFF AVE STE 17, IDAHO FALLS, ID 83404-6372
- **Practice address phone:** (208) 524-7237
- **Mailing address:** PO BOX 30015, DEPT 594, SALT LAKE CITY, UT 84130-0015
- **Mailing address phone:** (800) 475-6236
- **Mailing address fax:** (706) 596-6712

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085B0100X | Body Imaging Physician | — | NULL | Yes |
| 2085B0100X | Body Imaging Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/27/2009
- **Last updated:** 01/05/2026