Provider Demographics
NPI:1821834789
Name:SMART SCAN MEDICAL IMAGING - WAUSAU, LLC
Entity type:Organization
Organization Name:SMART SCAN MEDICAL IMAGING - WAUSAU, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-878-9109
Mailing Address - Street 1:2106 SCHOFIELD AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2412
Mailing Address - Country:US
Mailing Address - Phone:715-318-6684
Mailing Address - Fax:
Practice Address - Street 1:2106 SCHOFIELD AVE STE 7
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-2412
Practice Address - Country:US
Practice Address - Phone:715-318-6684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology