1770826307 NPI number — MOBILE ULTRASOUND LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770826307 NPI number — MOBILE ULTRASOUND LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE ULTRASOUND LLC
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:
6
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:
1770826307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3319 N ELSTON AVE
Provider Second Line Business Mailing Address:
SUITE 252
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60618-5811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-508-2866
Provider Business Mailing Address Fax Number:
248-856-2577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2335 S LINDEN RD
Provider Second Line Business Practice Location Address:
SUITE B1
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-5497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-249-3837
Provider Business Practice Location Address Fax Number:
810-275-1263
Provider Enumeration Date:
04/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TREMONTI
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
BRANCH MANAGER
Authorized Official Telephone Number:
810-249-3837

Provider Taxonomy Codes

  • Taxonomy code: 246XC2903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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