MEDICARE: SONO-ASSIST IMAGING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471S1302X	Sonography Radiologic Technologist	122593	NC

General Provider Information

NPI Number	:	1336437060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONO-ASSIST IMAGING SERVICES, LLC

Provider Business Mailing Address
First Line	:	4801 E INDEPENDENCE BLVD
Second Line	:	STE. # 502
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-5400
Country	:	US
Telephone Number	:	704-728-7011
Fax Number	:	704-391-9746

Provider Business Practice Location Address
First Line	:	4801 E INDEPENDENCE BLVD
Second Line	:	STE. # 502
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-5400
Country	:	US
Telephone Number	:	704-728-7011
Fax Number	:	704-391-9746

Authorized Official
Title or Position	:	FOUNDER, CEO
Name	:	MS. LADELLA ROBLES
Credential	:	RDMS
Telephone Number	:	704-728-7011

Provider Enumeration Date	:	07/15/2011
Last Update Date	:	07/15/2011

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