=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851950158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMALLEST FOOTPRINTS 3D/4D ULTRASOUND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2019
-----------------------------------------------------
Last Update Date | 06/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8870 YOUREE DR
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71115-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-344-8021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8952 TURNER DR
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71118-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-344-8021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED DIAGNOSTIC MEDICAL SONO
-----------------------------------------------------
Name | MELISSA MURRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-344-8021
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0206X
-----------------------------------------------------
Taxonomy Name | Mammography Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------