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General NPI Number Information
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NPI Number | 1922344613
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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 | 12/27/2012
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 10500 W. LOOMIS RD. STE 130
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City | FRANKLIN
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State | WI
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Zip | 53132
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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. STE 130
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City | FRANKLIN
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State | WI
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Zip | 53132
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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
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Name | MICHAEL COLEMAN
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | XM110231
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License Number State | WI
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