=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093769655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIQUE ULTRASOUND IMAGING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 E 9TH ST
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33972-3367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-810-4419
-----------------------------------------------------
Fax | 239-369-7279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 E 9TH ST
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33972-3367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 239-369-7279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SONOGRAPHER
-----------------------------------------------------
Name | MR. WILLIAM JAMES RYBAK
-----------------------------------------------------
Credential | RDCS, RVT, RDMS
-----------------------------------------------------
Telephone | 239-810-4419
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | HCC6873
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------