Healthcare Provider Details

I. General information

NPI: 1154378024
Provider Name (Legal Business Name): ULTRASOUND TECHNICAL SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PINE ST UNIT L
CANTON MA
02021-3347
US

IV. Provider business mailing address

23 PINE ST UNIT L
CANTON MA
02021-3347
US

V. Phone/Fax

Practice location:
  • Phone: 617-791-1809
  • Fax:
Mailing address:
  • Phone: 617-791-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number4485
License Number StateMA

VIII. Authorized Official

Name: MR. JOSEPH M REDDISH
Title or Position: PRESIDENT
Credential: RDMS
Phone: 617-791-1809