Healthcare Provider Details

I. General information

NPI: 1265761506
Provider Name (Legal Business Name): SONO CARE OF EAST TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CHASE DR STE 106
TYLER TX
75701-9452
US

IV. Provider business mailing address

625 CHASE DR STE 106
TYLER TX
75701-9452
US

V. Phone/Fax

Practice location:
  • Phone: 903-520-3232
  • Fax: 903-705-7353
Mailing address:
  • Phone: 903-520-3232
  • Fax: 903-705-7353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number81047
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number31878
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number31878
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number31878
License Number StateTX

VIII. Authorized Official

Name: MRS. JULIE B WOOD
Title or Position: OWNER/SONOGRAPHER
Credential: ARDMS/RVT
Phone: 903-520-3232