Healthcare Provider Details

I. General information

NPI: 1326136383
Provider Name (Legal Business Name): MIDWEST ULTRASOUND SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 STATE ST
LAWRENCEVILLE IL
62439-1852
US

IV. Provider business mailing address

5617 N SUGAR CREEK RD
OLNEY IL
62450-4052
US

V. Phone/Fax

Practice location:
  • Phone: 618-943-7221
  • Fax:
Mailing address:
  • Phone: 618-395-2503
  • Fax: 618-395-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number21588
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number21588
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number21588
License Number StateIL

VIII. Authorized Official

Name: JEFFREY J LEE
Title or Position: PRESIDENT
Credential: RDMS,RDCS,RVT
Phone: 618-395-2503