Healthcare Provider Details

I. General information

NPI: 1093846263
Provider Name (Legal Business Name): ULTRASOUND AND ECHO CARDIOGRAM MEDICAL DIAGNOSTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5594 STATE ROUTE 7
ANDOVER OH
44003-0179
US

IV. Provider business mailing address

109 WALNUT STREET
CORTLAND OH
44410-1421
US

V. Phone/Fax

Practice location:
  • Phone: 440-293-2444
  • Fax: 440-293-2445
Mailing address:
  • Phone: 330-637-0348
  • Fax: 330-637-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JACK LANGE
Title or Position: PRESIDENT
Credential:
Phone: 330-637-0348