MEDICARE: ULTRASOUND LABORATORIES 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	2471V0105X	Vascular Sonography Radiologic Technologist	71989	CA
2	2471V0105X	Vascular Sonography Radiologic Technologist	71989
3	2085U0001X	Diagnostic Ultrasound Physician	71989
4	246X00000X	Cardiovascular Specialist/Technologist	71989
5	202K00000X	Phlebology Physician	71989

General Provider Information

NPI Number	:	1902173248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRASOUND LABORATORIES INC

Provider Business Mailing Address
First Line	:	PO BOX 4864
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-0864
Country	:	US
Telephone Number	:	408-829-6486
Fax Number	:	408-890-4770

Provider Business Practice Location Address
First Line	:	305 SOUTH DRIVE, 7
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-4207
Country	:	US
Telephone Number	:	408-829-6486
Fax Number	:	408-890-4770

Authorized Official
Title or Position	:	TECHNICAL DIRECTOR, PRESIDENT
Name	:	JOSEPH DANIEL MATTHEWS
Credential	:	RDMS, RVT, RDCS,RPHS
Telephone Number	:	408-829-6486

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	01/13/2015

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