Healthcare Provider Details

I. General information

NPI: 1265989172
Provider Name (Legal Business Name): CDA ULTRASOUND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N GOVERNMENT WAY SUITE J
COEUR D ALENE ID
83814-3658
US

IV. Provider business mailing address

2201 N GOVERNMENT WAY SUITE J
COEUR D ALENE ID
83814-3658
US

V. Phone/Fax

Practice location:
  • Phone: 208-261-2520
  • Fax:
Mailing address:
  • Phone: 208-261-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberARDMS79341
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License NumberARDMS52476
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberARDMS52476
License Number StateCA

VIII. Authorized Official

Name: TRAVIS ARMSTRONG
Title or Position: CEO
Credential: RDMS, RVT
Phone: 208-771-3882