Provider Demographics
NPI:1215112966
Name:MH IMAGING-KENOSHA LLC
Entity type:Organization
Organization Name:MH IMAGING-KENOSHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RADIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:MALCOM
Authorized Official - Middle Name:
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-988-7231
Mailing Address - Street 1:1020 35TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-1932
Mailing Address - Country:US
Mailing Address - Phone:262-842-1400
Mailing Address - Fax:262-842-1401
Practice Address - Street 1:1020 35TH STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-1932
Practice Address - Country:US
Practice Address - Phone:262-842-1400
Practice Address - Fax:262-842-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000092680Medicare PIN