Healthcare Provider Details

I. General information

NPI: 1710982384
Provider Name (Legal Business Name): ULTRASOUND DIAGNOSTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 11/09/2009
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

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

V. Phone/Fax

Practice location:
  • Phone: 623-878-5650
  • Fax: 623-878-5670
Mailing address:
  • Phone: 623-878-5650
  • Fax: 623-878-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberOTC 3451
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: MR. CHRISTOPHER TURNER
Title or Position: CEO
Credential:
Phone: 214-242-8500