Provider Demographics
NPI:1225407075
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:VP OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:414-807-5733
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 1:3525 E CALUMET ST STE 1500
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4181
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:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21309000Medicaid