Healthcare Provider Details

I. General information

NPI: 1902865413
Provider Name (Legal Business Name): PRECISION ULTRASOUND IMAGING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105B KATHERINE DRIVE
FLOWOOD MS
39232
US

IV. Provider business mailing address

105B KATHERINE DRIVE
FLOWOOD MS
39232
US

V. Phone/Fax

Practice location:
  • Phone: 601-573-0577
  • Fax: 601-939-6775
Mailing address:
  • Phone: 601-573-0577
  • Fax: 601-939-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number StateMS

VIII. Authorized Official

Name: MRS. MELISSA B KELLEY
Title or Position: PRESIDENT
Credential: RT RDMS RVT
Phone: 601-573-0577