Healthcare Provider Details

I. General information

NPI: 1124006721
Provider Name (Legal Business Name): ULTRASOUND DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7998 W THUNDERBIRD RD SUITE 108
PEORIA AZ
85381-4904
US

IV. Provider business mailing address

5055 KELLER SPRINGS RD SUITE 500
ADDISON TX
75001-5997
US

V. Phone/Fax

Practice location:
  • Phone: 623-878-5650
  • Fax:
Mailing address:
  • Phone: 214-242-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberOTC 3819
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER TURNER
Title or Position: CEO
Credential:
Phone: 214-242-8500