Healthcare Provider Details

I. General information

NPI: 1255777595
Provider Name (Legal Business Name): GILBERT ULTRASOUND SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 LARRY JOE HARLESS DRIVE SUITE 207
GILBERT WV
25621
US

IV. Provider business mailing address

18 ALEX LN
GILBERT WV
25621-9756
US

V. Phone/Fax

Practice location:
  • Phone: 304-664-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AVERY B RITCHIE
Title or Position: OWNER
Credential: ARDMS
Phone: 304-664-9946