MEDICARE: CARDIAC ULTRASOUND, INC

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	246XS1301X	Sonography Specialist/Technologist Cardiovascular		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PB0213	OTHER	PA	UNISOM MEDPLUS
3	028062600	OTHER	PA	BLACK LUNG

General Provider Information

NPI Number	:	1346202561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC ULTRASOUND, INC

Provider Business Mailing Address
First Line	:	631 SANDERSON ST
Second Line	:
City	:	THROOP
State	:	PA
Zip	:	18512-1255
Country	:	US
Telephone Number	:	570-489-0171
Fax Number	:	570-489-0185

Provider Business Practice Location Address
First Line	:	631 SANDERSON ST
Second Line	:
City	:	THROOP
State	:	PA
Zip	:	18512-1255
Country	:	US
Telephone Number	:	570-489-0171
Fax Number	:	570-489-0185

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN J KELLY
Credential	:	RCS
Telephone Number	:	570-489-0171

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	04/24/2008

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