Healthcare Provider Details

I. General information

NPI: 1619282183
Provider Name (Legal Business Name): ECHOFAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4056 THATCHER DR
AURORA IL
60504-5374
US

IV. Provider business mailing address

4056 THATCHER DR
AURORA IL
60504-5374
US

V. Phone/Fax

Practice location:
  • Phone: 630-457-6711
  • Fax:
Mailing address:
  • Phone: 630-457-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: RON TORRES
Title or Position: COOWNER
Credential:
Phone: 630-457-6711