Healthcare Provider Details

I. General information

NPI: 1215953823
Provider Name (Legal Business Name): DIAGNOSTIC & TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CRANBERRY BLVD
WESTON WI
54476
US

IV. Provider business mailing address

3401 CRANBERRY BLVD
WESTON WI
54476
US

V. Phone/Fax

Practice location:
  • Phone: 715-393-2489
  • Fax: 715-241-9475
Mailing address:
  • Phone: 715-393-2489
  • Fax: 715-241-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number54844
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number400055
License Number StateWI

VIII. Authorized Official

Name: COLLEEN CHISNELL
Title or Position: SENIOR DIRECTOR OF FINANCE
Credential:
Phone: 715-393-2499