Organization Name: | HALES CORNERS IMAGING, LLC |
NPI Number: | 1518913573 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EDWIN SAGE (MEMBER MANAGER) |
Mailing Address: | 11035 W Forest Home Ave Suite 103 Hales Corners |
State: | WI US |
Postal Code: | 531302541 |
Phone Number: | 4144256602 |
Fax Number: | 4144256604 |
NPI Enumeration Date: | 05/25/2006 |
NPI Last Update Date: | 12/07/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology |
Taxonomy Definition: |