1922391747 NPI number — WILLIAM L MASSIE

Table of content: (NPI 1922391747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922391747 NPI number — WILLIAM L MASSIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM L MASSIE
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:
ADVANCED DIAGNOSTIC ULTRASOUND
Provider Other Organization Name Type Code:
3
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:
1922391747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 E FLORIDA AVE STE 315
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEMET
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92544-8639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-929-7600
Provider Business Mailing Address Fax Number:
951-750-5089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 E FLORIDA AVE STE 315
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMET
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92544-8639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-929-7600
Provider Business Practice Location Address Fax Number:
951-750-5089
Provider Enumeration Date:
05/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MASSIE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
951-929-7600

Provider Taxonomy Codes

  • Taxonomy code: 2471S1302X , with the licence number:  10768 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10768 . This is a "SONOGRAPHER LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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