Basic Information
| Provider Information | |||||||||
| NPI: | 1780640532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHARED MAGNETIC RESONANCE IMAGING FACILITY, INC | ||||||||
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| OtherOrganizationName: | TURVILLE BAY MRI AND RADIATION ONCOLOGY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1104 JOHN NOLEN DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537131430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082516868 | ||||||||
| FaxNumber: | 6082514255 | ||||||||
| Practice Location | |||||||||
| Address1: | 1104 JOHN NOLEN DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537131430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082516868 | ||||||||
| FaxNumber: | 6082514255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | THIERMANN | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6082594438 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0203X | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation |
ID Information
| ID | Type | State | Issuer | Description | 32828800 | 05 | WI | MEDICAID |