Healthcare Provider Details

I. General information

NPI: 1154428597
Provider Name (Legal Business Name): ULTRA HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21913 US HWY 19 N
CLEARWATER FL
33765
US

IV. Provider business mailing address

21913 US HWY 19 N
CLEARWATER FL
33765
US

V. Phone/Fax

Practice location:
  • Phone: 727-669-5525
  • Fax: 727-669-8589
Mailing address:
  • Phone: 727-669-5525
  • Fax: 727-669-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC5325
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberHCC5325
License Number StateFL

VIII. Authorized Official

Name: MRS. DONNA JEAN DAMIANI
Title or Position: PRESIDENT
Credential:
Phone: 727-669-5525