Healthcare Provider Details

I. General information

NPI: 1376665224
Provider Name (Legal Business Name): ULTRASOUND OF BELVIDERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 LOGAN AVENUE
BELVIDERE IL
61008
US

IV. Provider business mailing address

1006 LOGAN AVENUE
BELVIDERE IL
61008
US

V. Phone/Fax

Practice location:
  • Phone: 815-988-3642
  • Fax: 815-544-4775
Mailing address:
  • Phone: 815-988-3642
  • Fax: 815-544-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: TINA SABITOSRA
Title or Position: OWNER
Credential:
Phone: 815-988-3642