Provider Demographics
NPI:1598099608
Name:VITAL IMAGING, LLC
Entity Type:Organization
Organization Name:VITAL IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BURLINGAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-774-7600
Mailing Address - Street 1:10500 W LOOMIS RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8030
Mailing Address - Country:US
Mailing Address - Phone:414-774-7600
Mailing Address - Fax:414-774-7100
Practice Address - Street 1:10500 W LOOMIS RD
Practice Address - Street 2:SUITE 132
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8030
Practice Address - Country:US
Practice Address - Phone:414-774-7600
Practice Address - Fax:414-774-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIXM110231261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology