NPIMap

Organization Active NPI

Hales Corners MRI, LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Hales Corners, WI
National Provider Identifier
1336195304
Registry record updated Jan 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
HALES CORNERS MRI, LLC
Practice address
11035 W Forest Home Ave
Suite 118
Hales Corners, WI 53130-2541
Phone
(414) 525-9000
Fax
(414) 525-9070
NPI assigned
May 25, 2006
Last updated
Jan 1, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 1, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Edwin C. Sage
Title
Administrative Manager
Phone
(877) 444-4540

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X Primary
Radiology Clinic/Center 261QR0200X

Addresses

Primary practice location

11035 W Forest Home Ave
Suite 118
Hales Corners, WI 53130-2541

Mailing address

1616 E Roosevelt Rd
Suite 5
Wheaton, IL 60187-6850
Phone (877) 444-4540

Other identifiers 2

IdentifierTypeStateIssuer
P00186791OtherRAIL ROAD MEDICARE PIN
32896300MedicaidWI

National Provider Directory

National Provider Directory

Locations

11035 W Forest Home Ave
#118
Hales Corners, WI 53130
Phone (414) 525-9000

11035 W Forest Home Ave
Ste 118
Hales Corners, WI 53130
Phone (414) 525-9000

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325376000000",
    "number": "1336195304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 E ROOSEVELT RD",
            "address_2": "SUITE 5",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601876850",
            "telephone_number": "877-444-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11035 W FOREST HOME AVE",
            "address_2": "SUITE 118",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531302541",
            "telephone_number": "414-525-9000",
            "fax_number": "414-525-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALES CORNERS MRI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2012-01-01",
        "status": "A",
        "authorized_official_last_name": "SAGE",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "ADMINISTRATIVE MANAGER",
        "authorized_official_telephone_number": "877-444-4540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE PIN",
            "identifier": "P00186791",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32896300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hales Corners, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.