Healthcare Provider Details

I. General information

NPI: 1578507810
Provider Name (Legal Business Name): ULTRA S IMAGING LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 RUBY CT #4
WEST BRANCH MI
48661-1165
US

IV. Provider business mailing address

231 RUBY CT #4
WEST BRANCH MI
48661-1165
US

V. Phone/Fax

Practice location:
  • Phone: 989-345-0527
  • Fax:
Mailing address:
  • Phone: 989-345-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY LEE SMITH
Title or Position: OWNER
Credential: RDMS, RTR
Phone: 989-345-0527