Provider Demographics
NPI:1720422850
Name:MH IMAGING-RACINE LLC
Entity type:Organization
Organization Name:MH IMAGING-RACINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALCOM
Authorized Official - Middle Name:
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-988-7231
Mailing Address - Street 1:6800 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3951
Mailing Address - Country:US
Mailing Address - Phone:262-321-7970
Mailing Address - Fax:262-321-7995
Practice Address - Street 1:6800 WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-3951
Practice Address - Country:US
Practice Address - Phone:262-321-7970
Practice Address - Fax:262-321-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29922-20174400000X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty