Provider Demographics
NPI: | 1164969838 |
---|---|
Name: | SMART CHOICE MRI, LLC |
Entity Type: | Organization |
Organization Name: | SMART CHOICE MRI, LLC |
Other - Org Name: | SMART CHOICE MRI VERNON HILLS |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RICHARD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ANDERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 844-633-3674 |
Mailing Address - Street 1: | 10532 N PORT WASHINGTON RD STE 1B |
Mailing Address - Street 2: | |
Mailing Address - City: | MEQUON |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53092-5563 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 844-633-3674 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 850 N MILWAUKEE AVE STE 103 |
Practice Address - Street 2: | |
Practice Address - City: | VERNON HILLS |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60061-1553 |
Practice Address - Country: | US |
Practice Address - Phone: | 844-633-3674 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | SMART CHOICE MRI, LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-01-19 |
Last Update Date: | 2017-01-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM1200X | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |