Organization
TETON MRI OF IDAHO FALLS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BONNIE C. GRAY (ADMINISTRATIVE ASSISTANT)
(208) 552-0828
Entity
Organization
Contact information
Practice address
2060 S WOODRUFF AVE, IDAHO FALLS, ID 83404-6396
(208) 552-0828
(208) 552-0829
Mailing address
2060 S WOODRUFF AVE, IDAHO FALLS, ID 83404-6396
(208) 552-0828
(208) 552-0829
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
09/06/2005
Last updated
07/10/2007
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