MEDICARE: ULTRASOUND ENTERPRISE 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	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700877297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRASOUND ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	165 FRONTAGE ROAD
Second Line	:	SUITE B
City	:	GRAY
State	:	LA
Zip	:	70359
Country	:	US
Telephone Number	:	985-580-2888
Fax Number	:	985-851-7526

Provider Business Practice Location Address
First Line	:	165 FRONTAGE ROAD
Second Line	:	SUITE B
City	:	GRAY
State	:	LA
Zip	:	70359
Country	:	US
Telephone Number	:	985-580-2888
Fax Number	:	985-851-7526

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JAMES W. HOLMES
Credential	:
Telephone Number	:	337-291-9161

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	01/04/2008

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Directions to “ULTRASOUND ENTERPRISE LLC ” Practice Location

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