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General NPI Number Information
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NPI Number | 1659630879
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Entity Type | Organization
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Legal Business Name | INDIANA ULTRASOUND LLC
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 2055 W 64TH PL
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3114
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Country | US
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Telephone | 219-746-6662
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Fax |
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Provider Business Mailing Address
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Address Line | 2055 W 64TH PL
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3114
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Country | US
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Telephone | 219-746-6662
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. GRACE SMITH
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Credential | RDMS
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Telephone | 219-746-6662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State | IN
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