Provider Demographics
NPI:1457918781
Name:SMART CHOICE MRI LLC
Entity Type:Organization
Organization Name:SMART CHOICE MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-983-7196
Mailing Address - Street 1:737 N MICHIGAN AVE STE 2200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6750
Mailing Address - Country:US
Mailing Address - Phone:312-983-7196
Mailing Address - Fax:414-755-7706
Practice Address - Street 1:1580 HERITAGE BLVD
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-9418
Practice Address - Country:US
Practice Address - Phone:844-633-3674
Practice Address - Fax:844-332-3974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)