Provider Demographics
NPI:1407081060
Name:TETON RADIOLOGY MADISON LLC
Entity type:Organization
Organization Name:TETON RADIOLOGY MADISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STROBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-542-5000
Mailing Address - Street 1:PO BOX 3007
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-3007
Mailing Address - Country:US
Mailing Address - Phone:208-552-8772
Mailing Address - Fax:208-523-2025
Practice Address - Street 1:425 E 4TH N
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5390
Practice Address - Country:US
Practice Address - Phone:208-356-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty