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NPI Code Detail

MEDICARE: ST CLARE IMAGING SERVICES, LLC

MEDICARE: ST CLARE IMAGING SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11043767OTHERWIPHYS PLUS PROV #
2567258OTHERWIDEANCARE PROV #
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639152770
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST CLARE IMAGING SERVICES, LLC
Provider Business Mailing Address
First Line : 707 14TH ST
Second Line :
City : BARABOO
State : WI
Zip : 53913-1539
Country : US
Telephone Number : 608-356-1400
Fax Number :
Provider Business Practice Location Address
First Line : 707 14TH ST
Second Line :
City : BARABOO
State : WI
Zip : 53913-1539
Country : US
Telephone Number : 608-356-1400
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF FINANCE
Name : TROY WALKER
Credential :
Telephone Number : 608-356-1423
Provider Enumeration Date : 11/22/2005
Last Update Date : 11/27/2023

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