Organization
TETON OPEN MRI OF POCATELLO, LLC
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
246 N 18TH AVE, POCATELLO, ID 83201-3356
(208) 552-0828
(208) 552-0829
Mailing address
246 N 18TH AVE, POCATELLO, ID 83201-3356
(208) 552-0828
(208) 552-0829
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
02/08/2006
Last updated
08/22/2020
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