Healthcare Provider Details

I. General information

NPI: 1114312659
Provider Name (Legal Business Name): UNITED SHOCKWAVE SERVICES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 STEAM WAY STE A102
ROUND ROCK TX
78665-2233
US

IV. Provider business mailing address

PO BOX 95439
GRAPEVINE TX
76099-9735
US

V. Phone/Fax

Practice location:
  • Phone: 877-465-4845
  • Fax: 847-544-5955
Mailing address:
  • Phone: 877-465-4845
  • Fax: 847-297-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3514
License Number StateNM

VIII. Authorized Official

Name: MR. JEFFREY NORRIS
Title or Position: PRESIDENT
Credential:
Phone: 847-544-5853