Provider Demographics
NPI:1336920420
Name:TETON RADIOLOGY CALDWELL
Entity Type:Organization
Organization Name:TETON RADIOLOGY CALDWELL
Other - Org Name:TETON RADIOLOGY CALDWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
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 1:2001 S WOODRUFF AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6372
Mailing Address - Country:US
Mailing Address - Phone:208-524-7237
Mailing Address - Fax:208-522-3017
Practice Address - Street 1:4519 ENTERPRISE WAY
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-8055
Practice Address - Country:US
Practice Address - Phone:208-454-0742
Practice Address - Fax:208-455-7538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty