# TETON SPORTS & SPINE IMAGING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427574987
- **Authorized official:** SHAUN ANDRIKOPOULOS (MANAGER/PARTNER)
- **Authorized official phone:** (307) 201-5380

## Contact information

- **Practice address:** 250 SCOTT LN STE 110, JACKSON, WY 83001-8060
- **Practice address phone:** (307) 201-5380
- **Practice address fax:** (307) 201-5202
- **Mailing address:** PO BOX 736, WHEAT RIDGE, CO 80034-0736
- **Mailing address phone:** (307) 218-8225
- **Mailing address fax:** (307) 218-8226

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | NULL | Yes |
| 261QR0200X | Radiology Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/16/2017
- **Last updated:** 09/26/2024