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
—
—
Other
Enumeration date
04/27/2009
Last updated
01/05/2026
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