=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780640532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARED MAGNETIC RESONANCE IMAGING FACILITY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2006
-----------------------------------------------------
Last Update Date | 01/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1104 JOHN NOLEN DR SUITE 1
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53713-1430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-251-6868
-----------------------------------------------------
Fax | 608-251-4255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1104 JOHN NOLEN DR SUITE 1
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53713-1430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-251-6868
-----------------------------------------------------
Fax | 608-251-4255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | BARBARA J THIERMANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-259-4438
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0203X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------