Healthcare Provider Details

I. General information

NPI: 1336151554
Provider Name (Legal Business Name): WAVES ADVANCED ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HERITAGE GREEN DR
HIAWATHA IA
52233-2326
US

IV. Provider business mailing address

2200 HERITAGE GREEN DR
HIAWATHA IA
52233-2326
US

V. Phone/Fax

Practice location:
  • Phone: 319-832-2229
  • Fax:
Mailing address:
  • Phone: 319-832-2229
  • Fax: 800-426-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. STACEY MROZINSKI
Title or Position: PRESIDENT
Credential:
Phone: 319-899-4998