Healthcare Provider Details

I. General information

NPI: 1497931547
Provider Name (Legal Business Name): SONORUS MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 OLD DECATUR RD SUITE 100
ALVORD TX
76225-7748
US

IV. Provider business mailing address

4285 OLD DECATUR RD SUITE 100
ALVORD TX
76225-7748
US

V. Phone/Fax

Practice location:
  • Phone: 940-389-0647
  • Fax:
Mailing address:
  • Phone: 940-389-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number800921018
License Number StateTX

VIII. Authorized Official

Name: MRS. NATALIE JILL DAVIS
Title or Position: OWNER / OPERATOR
Credential: BBA, RDMS, RVT
Phone: 940-389-0647