Healthcare Provider Details

I. General information

NPI: 1154375244
Provider Name (Legal Business Name): SONOSOURCE DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6773 INDUSTRIAL PKWY
NORTH OLMSTED OH
44070-6303
US

IV. Provider business mailing address

5275 NAIMAN PKWY SUITE E
SOLON OH
44139-1016
US

V. Phone/Fax

Practice location:
  • Phone: 440-645-7822
  • Fax: 440-542-9482
Mailing address:
  • Phone: 440-542-1515
  • Fax: 440-542-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: KEITH C MARCHAND
Title or Position: PRESIDENT
Credential:
Phone: 440-645-4626