Healthcare Provider Details

I. General information

NPI: 1396333605
Provider Name (Legal Business Name): DURANGO ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E 8TH AVE STE 201
DURANGO CO
81301-5768
US

IV. Provider business mailing address

270 E 8TH AVE STE 201
DURANGO CO
81301-5768
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-7997
  • Fax: 970-247-7996
Mailing address:
  • Phone: 970-247-7997
  • Fax: 970-247-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: LAUREL A CAMPBELL
Title or Position: SONOGRAPHER/OWNER
Credential: BS, RDMS, RVT
Phone: 970-247-7997