MEDICARE: SONORUS MEDICAL IMAGING, 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	261Q00000X	Clinic/Center	800921018	TX

General Provider Information

NPI Number	:	1497931547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONORUS MEDICAL IMAGING, LLC

Provider Business Mailing Address
First Line	:	4285 OLD DECATUR RD
Second Line	:	SUITE 100
City	:	ALVORD
State	:	TX
Zip	:	76225-7748
Country	:	US
Telephone Number	:	940-389-0647
Fax Number	:

Provider Business Practice Location Address
First Line	:	4285 OLD DECATUR RD
Second Line	:	SUITE 100
City	:	ALVORD
State	:	TX
Zip	:	76225-7748
Country	:	US
Telephone Number	:	940-389-0647
Fax Number	:

Authorized Official
Title or Position	:	OWNER / OPERATOR
Name	:	MRS. NATALIE JILL DAVIS
Credential	:	BBA, RDMS, RVT
Telephone Number	:	940-389-0647

Provider Enumeration Date	:	01/18/2008
Last Update Date	:	01/18/2008

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