Provider Demographics
NPI:1215480942
Name:SMART CHOICE MRI, LLC
Entity type:Organization
Organization Name:SMART CHOICE MRI, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:WIKSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-431-0309
Mailing Address - Street 1:10532 N PORT WASHINGTON RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5563
Mailing Address - Country:US
Mailing Address - Phone:844-633-3674
Mailing Address - Fax:414-672-2292
Practice Address - Street 1:1704 E 66TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55423
Practice Address - Country:US
Practice Address - Phone:844-633-3674
Practice Address - Fax:414-672-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)