Healthcare Provider Details

I. General information

NPI: 1114276797
Provider Name (Legal Business Name): SOUND IMAGING INC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 S BROADWAY ST
POPLAR BLUFF MO
63901-6342
US

IV. Provider business mailing address

1614 S BROADWAY ST
POPLAR BLUFF MO
63901-6342
US

V. Phone/Fax

Practice location:
  • Phone: 573-785-0202
  • Fax: 573-785-1211
Mailing address:
  • Phone: 573-785-0202
  • Fax: 573-785-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GAYLE DEEM
Title or Position: OWNER
Credential:
Phone: 573-785-0202