Healthcare Provider Details

I. General information

NPI: 1467487066
Provider Name (Legal Business Name): FORT LAUDERDALE MOBILE ULTRASOUND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 NW 4TH ST SUITE 107
PLANTATION FL
33317-2234
US

IV. Provider business mailing address

PO BOX 5286
FT LAUDERDALE FL
33310-5286
US

V. Phone/Fax

Practice location:
  • Phone: 954-566-4551
  • Fax: 954-566-4565
Mailing address:
  • Phone: 954-566-4551
  • Fax: 954-566-4565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HOWARD S DEKKERS
Title or Position: CEO
Credential:
Phone: 954-566-4551