Provider Demographics
NPI:1184704611
Name:ENHANCED MEDICAL IMAGING
Entity type:Organization
Organization Name:ENHANCED MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BENEFITS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-554-9787
Mailing Address - Street 1:5439 DURAND AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5058
Mailing Address - Country:US
Mailing Address - Phone:262-554-9787
Mailing Address - Fax:262-554-9782
Practice Address - Street 1:5439 DURAND AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5058
Practice Address - Country:US
Practice Address - Phone:262-554-9787
Practice Address - Fax:262-554-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty