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General NPI Number Information
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NPI Number | 1265989172
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Entity Type | Organization
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Legal Business Name | CDA ULTRASOUND, INC.
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 2201 N GOVERNMENT WAY SUITE J
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3658
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Country | US
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Telephone | 208-261-2520
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 N GOVERNMENT WAY SUITE J
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3658
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Country | US
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Telephone | 208-261-2520
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TRAVIS ARMSTRONG
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Credential | RDMS, RVT
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Telephone | 208-771-3882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | ARDMS79341
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | ARDMS52476
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | ARDMS52476
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License Number State | CA
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