Healthcare Provider Details

I. General information

NPI: 1417491655
Provider Name (Legal Business Name): SMART CHOICE MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 E BOUGHTON RD
BOLINGBROOK IL
60440-2281
US

IV. Provider business mailing address

10532 N PORT WASHINGTON RD # R SUITE 1B
MEQUON WI
53092-5563
US

V. Phone/Fax

Practice location:
  • Phone: 414-431-0309
  • Fax: 414-672-2292
Mailing address:
  • Phone: 414-431-0309
  • Fax: 414-672-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICK ANDERSON
Title or Position: CEO
Credential:
Phone: 414-431-0309