NPIMap

Organization Active NPI

Teton Nuclear Medicine Service LLC

  • Nuclear Imaging & Therapy Physician
  • Idaho Falls, ID
National Provider Identifier
1265612543
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nuclear Imaging & Therapy PhysicianTaxonomy code 207UN0902X
Legal business name
TETON NUCLEAR MEDICINE SERVICE LLC
Practice address
2001 S Woodruff Ave
Ste 20
Idaho Falls, ID 83404-6374
Phone
(208) 525-3201
NPI assigned
Nov 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Danny L Davis
Title
Manager
Phone
(208) 525-3201

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207UN0901X
Nuclear Imaging & Therapy PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207UN0902X Primary

Addresses

Primary practice location

2001 S Woodruff Ave
Ste 20
Idaho Falls, ID 83404-6374

Mailing address

2001 S Woodruff Ave
Ste 20
Idaho Falls, ID 83404-6374
Phone (208) 525-3201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080128000145 ID Part B Supplier - Clinic/Group Practice 8123100328 Receives reassigned benefits from 4 practitioners
Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194220800000",
    "number": "1265612543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE",
            "address_2": "STE 20",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046374",
            "telephone_number": "208-525-3201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE",
            "address_2": "STE 20",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046374",
            "telephone_number": "208-525-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON NUCLEAR MEDICINE SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-05",
        "last_updated": "2007-11-05",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "DANNY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-525-3201",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207UN0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0902X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.