Healthcare Provider Details

I. General information

NPI: 1457918781
Provider Name (Legal Business Name): SMART CHOICE MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 HERITAGE BLVD
WEST SALEM WI
54669-9418
US

IV. Provider business mailing address

737 N MICHIGAN AVE STE 2200
CHICAGO IL
60611-6750
US

V. Phone/Fax

Practice location:
  • Phone: 844-633-3674
  • Fax: 844-332-3974
Mailing address:
  • Phone: 312-983-7196
  • Fax: 414-755-7706

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: GEORGE PETKIEWICZ
Title or Position: BILLING MANAGER
Credential:
Phone: 312-983-7196