Provider Demographics
NPI:1417494196
Name:SMART CHOICE MRI, LLC
Entity Type:Organization
Organization Name:SMART CHOICE MRI, LLC
Other - Org Name:SMART CHOICE MRI EDEN PRAIRIE
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:414-672-2292
Practice Address - Street 1:13000 TECHNOLOGY DR STE 100
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3606
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?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)