# HALES CORNERS MRI, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336195304
- **Authorized official:** MR. EDWIN C. SAGE (ADMINISTRATIVE MANAGER)
- **Authorized official phone:** (877) 444-4540

## Contact information

- **Practice address:** 11035 W FOREST HOME AVE, SUITE 118, HALES CORNERS, WI 53130-2541
- **Practice address phone:** (414) 525-9000
- **Practice address fax:** (414) 525-9070
- **Mailing address:** 1616 E ROOSEVELT RD, SUITE 5, WHEATON, IL 60187-6850
- **Mailing address phone:** (877) 444-4540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | NULL | Yes |
| 261QR0200X | Radiology Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 01/01/2012