=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225105430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROL A MACLEAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 FRIENDLY LN
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-4704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-271-4949
-----------------------------------------------------
Fax | 206-203-4697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 FRIENDLY LN
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-4704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-271-4949
-----------------------------------------------------
Fax | 206-203-4697
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER SONOGRAPHER
-----------------------------------------------------
Name | CAROL ANN MACLEAN
-----------------------------------------------------
Credential | ARDMS AB OB RVT RT
-----------------------------------------------------
Telephone | 828-271-4949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------