Provider Demographics
NPI:1598056335
Name:GERMANTOWN MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:GERMANTOWN MEDICAL IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-985-5260
Mailing Address - Street 1:PO BOX 6368
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61125-1368
Mailing Address - Country:US
Mailing Address - Phone:815-985-5260
Mailing Address - Fax:
Practice Address - Street 1:W178N9912 RIVERCREST DR
Practice Address - Street 2:SUITE 102-A
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4645
Practice Address - Country:US
Practice Address - Phone:815-985-5260
Practice Address - Fax:815-885-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology