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General NPI Number Information
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NPI Number | 1760691323
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Entity Type | Organization
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Legal Business Name | TREASURE COAST ULTRASOUND INC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 04/12/2009
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Provider Practice Location Address
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Address Line | 1998 SW AUTUMNWOOD WAY
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City | PALM CITY
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State | FL
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Zip | 34990-7748
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Country | US
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Telephone | 772-979-5652
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Fax | 772-781-8896
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Provider Business Mailing Address
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Address Line | 1998 SW AUTUMNWOOD WAY
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City | PALM CITY
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State | FL
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Zip | 34990-7748
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Country | US
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Telephone | 772-979-5652
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Fax | 772-781-8896
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Authorized Official
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Title or Position | OWNER
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Name | MR. DARREL MCKILLOP
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Credential |
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Telephone | 772-979-5652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | HCC8398
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License Number State | FL
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