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General NPI Number Information
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NPI Number | 1457356321
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Entity Type | Organization
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Legal Business Name | WEST BEND OPEN MRI, LLC
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1016 GATEWAY CT
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City | WEST BEND
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State | WI
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Zip | 53095-8541
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Country | US
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Telephone | 262-334-7674
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Fax | 262-334-7692
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Provider Business Mailing Address
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Address Line | 1016 GATEWAY CT
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City | WEST BEND
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State | WI
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Zip | 53095-8541
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Country | US
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Telephone | 262-334-7674
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Fax | 262-334-7692
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Authorized Official
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Title or Position | MANAGER
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Name | MR. STEVEN A. METCALF
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Credential | MBA
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Telephone | 262-334-7674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State | WI
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