Provider Demographics
NPI:1972703031
Name:PEDIATRIC DIAGNOSTIC IMAGING, S.C.
Entity type:Organization
Organization Name:PEDIATRIC DIAGNOSTIC IMAGING, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:414-847-1800
Mailing Address - Street 1:10500 W LOOMIS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8111
Mailing Address - Country:US
Mailing Address - Phone:414-847-1800
Mailing Address - Fax:414-847-1820
Practice Address - Street 1:10500 W LOOMIS RD STE 120
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8111
Practice Address - Country:US
Practice Address - Phone:414-847-1800
Practice Address - Fax:414-847-1820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC DIAGNOSTIC IMAGING, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology