Healthcare Provider Details

I. General information

NPI: 1710840905
Provider Name (Legal Business Name): WELLINGTON DIAGNOSTIC ULTRASOUND IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3500 FLUSHING RD STE 104
FLINT MI
48504-4247
US

IV. Provider business mailing address

PO BOX 7087
FLINT MI
48507-0087
US

V. Phone/Fax

Practice location:
  • Phone: 469-269-4986
  • Fax:
Mailing address:
  • Phone: 469-269-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDRA HOUSTON
Title or Position: PRESIDENT
Credential:
Phone: 469-269-4986