MEDICARE: MOBILE ULTRASOUND 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	246XC2903X	Vascular Specialist/Technologist Cardiovascular

General Provider Information

NPI Number	:	1861738304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE ULTRASOUND LLC

Provider Business Mailing Address
First Line	:	3319 N ELSTON AVE
Second Line	:	SUITE 252
City	:	CHICAGO
State	:	IL
Zip	:	60618-5811
Country	:	US
Telephone Number	:	314-272-4161
Fax Number	:

Provider Business Practice Location Address
First Line	:	10016 OFFICE CENTER AVE
Second Line	:	SUITE 100A
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-1468
Country	:	US
Telephone Number	:	314-272-4161
Fax Number	:	314-735-4418

Authorized Official
Title or Position	:	BRANCH MANAGER
Name	:	JOHN HOLLAND
Credential	:
Telephone Number	:	314-272-4161

Provider Enumeration Date	:	01/02/2013
Last Update Date	:	02/26/2013

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Directions to “MOBILE ULTRASOUND LLC ” Practice Location

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