Healthcare Provider Details

I. General information

NPI: 1295784726
Provider Name (Legal Business Name): MCMC RADIOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 W CAPITOL DR
MILWAUKEE WI
53216-2239
US

IV. Provider business mailing address

5100 MONTOUR RD
EMMETT ID
83617-5016
US

V. Phone/Fax

Practice location:
  • Phone: 414-873-7000
  • Fax: 414-873-8632
Mailing address:
  • Phone: 208-584-3526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT C. HELENIAK
Title or Position: MANAGING MEMBER
Credential:
Phone: 208-584-3526