Organization
TETON SPORTS & SPINE IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN ANDRIKOPOULOS (MANAGER/PARTNER)
(307) 201-5380
Entity
Organization
Contact information
Practice address
250 SCOTT LN STE 110, JACKSON, WY 83001-8060
(307) 201-5380
(307) 201-5202
Mailing address
PO BOX 736, WHEAT RIDGE, CO 80034-0736
(307) 218-8225
(307) 218-8226
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427574987
—
WY
Enumeration date
08/16/2017
Last updated
09/26/2024
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