Organization
HALES CORNERS MRI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN C. SAGE (ADMINISTRATIVE MANAGER)
(877) 444-4540
Entity
Organization
Contact information
Practice address
11035 W FOREST HOME AVE, SUITE 118, HALES CORNERS, WI 53130-2541
(414) 525-9000
(414) 525-9070
Mailing address
1616 E ROOSEVELT RD, SUITE 5, WHEATON, IL 60187-6850
(877) 444-4540
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32896300
—
WI
01
—
P00186791
RAIL ROAD MEDICARE PIN
—
Enumeration date
05/25/2006
Last updated
01/01/2012
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