Healthcare Provider Details

I. General information

NPI: 1477003267
Provider Name (Legal Business Name): SMART CHOICE MRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2752 US HIGHWAY 34
OSWEGO IL
60543
US

IV. Provider business mailing address

2752 US HIGHWAY 34
OSWEGO IL
60543-8301
US

V. Phone/Fax

Practice location:
  • Phone: 844-633-3674
  • Fax: 414-672-2292
Mailing address:
  • Phone: 844-633-3674
  • 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: ROLAND WIKSTROM
Title or Position: CCO
Credential:
Phone: 414-431-0309