Provider Demographics
NPI:1215925839
Name:MMC MRI LLC
Entity type:Organization
Organization Name:MMC MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESMUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-541-8020
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-541-8020
Mailing Address - Fax:262-650-4398
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-541-8020
Practice Address - Fax:262-650-4398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21268000Medicaid
WI92160Medicare ID - Type Unspecified