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General NPI Number Information
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NPI Number | 1790438216
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Entity Type | Organization
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Legal Business Name | T & C ULTRASOUND LLC
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 5 GINGER CREEK VLG
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City | GLEN CARBON
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State | IL
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Zip | 62034-3517
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Country | US
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Telephone | 636-226-6504
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Fax |
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Provider Business Mailing Address
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Address Line | 5 GINGER CREEK VLG
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City | GLEN CARBON
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State | IL
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Zip | 62034-3517
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Country | US
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Telephone | 636-226-6504
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS COX
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Credential |
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Telephone | 636-226-6504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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