MEDICARE: MH IMAGING-RACINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	29922-20	WI
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1720422850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MH IMAGING-RACINE LLC

Provider Business Mailing Address
First Line	:	6800 WASHINGTON AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-3951
Country	:	US
Telephone Number	:	262-321-7970
Fax Number	:	262-321-7995

Provider Business Practice Location Address
First Line	:	6800 WASHINGTON AVE STE B
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-3951
Country	:	US
Telephone Number	:	262-321-7970
Fax Number	:	262-321-7995

Authorized Official
Title or Position	:	OWNER
Name	:	MALCOM HATFIELD
Credential	:
Telephone Number	:	262-988-7231

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	01/12/2023

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Directions to “MH IMAGING-RACINE LLC ” Practice Location

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