Healthcare Provider Details

I. General information

NPI: 1922131200
Provider Name (Legal Business Name): NORTH CAROLINA MOBILE ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2554 LEWISVILLE-CLEMMONS ROAD SUITE 201, BOX 11
CLEMMONS NC
27012-8110
US

IV. Provider business mailing address

2554 LEWISVILLE-CLEMMONS ROAD SUITE 201, BOX 11
CLEMMONS NC
27012-8110
US

V. Phone/Fax

Practice location:
  • Phone: 800-983-9840
  • Fax: 336-245-2017
Mailing address:
  • Phone: 800-983-9840
  • Fax: 336-245-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL DARRYL SMITH SR.
Title or Position: OWNER
Credential:
Phone: 800-983-9840