Provider Demographics
NPI:1881636546
Name:NORTHSHORE RADIOLOGY ASSOCIATES OF MADISON SC
Entity Type:Organization
Organization Name:NORTHSHORE RADIOLOGY ASSOCIATES OF MADISON SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:O ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:STIENNON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:920-846-3444
Mailing Address - Street 1:200 E WASHINGTON ST
Mailing Address - Street 2:P O BOX 8031
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5490
Mailing Address - Country:US
Mailing Address - Phone:866-313-0336
Mailing Address - Fax:920-739-0124
Practice Address - Street 1:855 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1241
Practice Address - Country:US
Practice Address - Phone:920-846-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32718400Medicaid
WI=========014OtherBLUE CROSS GROUP #
WI=========014OtherBLUE CROSS GROUP #