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General NPI Number Information
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NPI Number | 1598099608
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Entity Type | Organization
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Legal Business Name | VITAL IMAGING, LLC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 10500 W LOOMIS RD SUITE 132
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City | FRANKLIN
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State | WI
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Zip | 53132-8030
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Country | US
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Telephone | 414-774-7600
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Fax | 414-774-7100
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Provider Business Mailing Address
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Address Line | 10500 W LOOMIS RD SUITE 132
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City | FRANKLIN
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State | WI
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Zip | 53132-8030
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Country | US
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Telephone | 414-774-7600
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Fax | 414-774-7100
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. STEPHEN ARTHUR BURLINGAME
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Credential |
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Telephone | 414-774-7600
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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 | XM110231
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License Number State | WI
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