Provider Demographics
NPI:1326058645
Name:SMART CHOICE MRI LLC
Entity Type:Organization
Organization Name:SMART CHOICE MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-807-5733
Mailing Address - Street 1:10532 NORTH PORT WASHINGTON ROAD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MEGQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:414-431-0309
Mailing Address - Fax:414-672-2292
Practice Address - Street 1:1621 MILLER PARK WAY
Practice Address - Street 2:
Practice Address - City:WEST MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3605
Practice Address - Country:US
Practice Address - Phone:414-431-0309
Practice Address - Fax:414-672-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21309000Medicaid
WI21309000Medicaid