Healthcare Provider Details

I. General information

NPI: 1447851290
Provider Name (Legal Business Name): PERFORMANCE ULTRASOUND AND INTERVENTION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8427 E BASELINE RD STE 101
MESA AZ
85209-4381
US

IV. Provider business mailing address

8427 E BASELINE RD STE 101
MESA AZ
85209-4381
US

V. Phone/Fax

Practice location:
  • Phone: 480-357-6500
  • Fax: 480-357-6515
Mailing address:
  • Phone: 480-357-6500
  • Fax: 480-357-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC BLOOM
Title or Position: OWNER
Credential: PT, DPT
Phone: 480-357-6500