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General NPI Number Information
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NPI Number | 1598056335
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Entity Type | Organization
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Legal Business Name | GERMANTOWN MEDICAL IMAGING, LLC
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | W178N9912 RIVERCREST DR SUITE 102-A
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City | GERMANTOWN
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State | WI
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Zip | 53022-4645
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Country | US
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Telephone | 815-985-5260
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Fax | 815-885-1062
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Provider Business Mailing Address
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Address Line | PO BOX 6368
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City | ROCKFORD
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State | IL
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Zip | 61125-1368
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Country | US
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Telephone | 815-985-5260
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. STEVEN A. METCALF
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Credential |
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Telephone | 815-985-5260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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