Provider Demographics
NPI:1780640532
Name:SHARED MAGNETIC RESONANCE IMAGING FACILITY, INC
Entity Type:Organization
Organization Name:SHARED MAGNETIC RESONANCE IMAGING FACILITY, INC
Other - Org Name:SSM HEALTH CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:THIERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-259-4438
Mailing Address - Street 1:1104 JOHN NOLEN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1430
Mailing Address - Country:US
Mailing Address - Phone:608-251-6868
Mailing Address - Fax:608-251-4255
Practice Address - Street 1:1104 JOHN NOLEN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1430
Practice Address - Country:US
Practice Address - Phone:608-251-6868
Practice Address - Fax:608-251-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32828800Medicaid
WI000074550Medicare ID - Type Unspecified