Healthcare Provider Details

I. General information

NPI: 1952608325
Provider Name (Legal Business Name): ON-SITE ULTRASOUND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 JUNE ST NE
ALBUQUERQUE NM
87112-3146
US

IV. Provider business mailing address

1804 JUNE ST NE
ALBUQUERQUE NM
87112-3146
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-9836
  • Fax: 866-688-1632
Mailing address:
  • Phone: 505-843-9836
  • Fax: 866-688-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. OLENA DZIUBA
Title or Position: CFO
Credential: BBA
Phone: 505-573-2495