MEDICARE: PIQUE ULTRASOUND IMAGING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	HCC6873	FL

General Provider Information

NPI Number	:	1093769655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIQUE ULTRASOUND IMAGING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1301 E 9TH ST
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33972-3367
Country	:	US
Telephone Number	:
Fax Number	:	239-369-7279

Provider Business Practice Location Address
First Line	:	1301 E 9TH ST
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33972-3367
Country	:	US
Telephone Number	:	239-810-4419
Fax Number	:	239-369-7279

Authorized Official
Title or Position	:	OWNER/SONOGRAPHER
Name	:	MR. WILLIAM JAMES RYBAK
Credential	:	RDCS, RVT, RDMS
Telephone Number	:	239-810-4419

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/22/2020

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