MEDICARE: MIDWEST MOBILE ULTRASOUND, 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	261QR0200X	Radiology Clinic/Center		IN

General Provider Information

NPI Number	:	1336260066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST MOBILE ULTRASOUND, LLC

Provider Business Mailing Address
First Line	:	1031 MOUNT AUBURN RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-8226
Country	:	US
Telephone Number	:	812-425-4682
Fax Number	:	812-425-2564

Provider Business Practice Location Address
First Line	:	1031 MOUNT AUBURN RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-8226
Country	:	US
Telephone Number	:	812-425-4682
Fax Number	:	812-425-2564

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREG ASHBY
Credential	:
Telephone Number	:	812-425-4681

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	11/20/2012

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