Healthcare Provider Details

I. General information

NPI: 1861738304
Provider Name (Legal Business Name): MOBILE ULTRASOUND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10016 OFFICE CENTER AVE SUITE 100A
SAINT LOUIS MO
63128-1468
US

IV. Provider business mailing address

3319 N ELSTON AVE SUITE 252
CHICAGO IL
60618-5811
US

V. Phone/Fax

Practice location:
  • Phone: 314-272-4161
  • Fax: 314-735-4418
Mailing address:
  • Phone: 314-272-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: JOHN HOLLAND
Title or Position: BRANCH MANAGER
Credential:
Phone: 314-272-4161