1609817907 NPI number — DIAGNOSTIC ULTRASOUND SERVICES, INC

Table of content: (NPI 1609817907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609817907 NPI number — DIAGNOSTIC ULTRASOUND SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC ULTRASOUND SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609817907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9023
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67277-0023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-687-3553
Provider Business Mailing Address Fax Number:
316-440-3344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7570 W. 21ST STREET NORTH
Provider Second Line Business Practice Location Address:
BUILDING 1050 SUITE D
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67205
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
316-558-8660
Provider Business Practice Location Address Fax Number:
316-558-8662
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RHOADES
Authorized Official First Name:
DOREN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
316-558-8660

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200334900A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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