Provider Demographics
NPI:1063013761
Name:CONVENIENT ULTRASOUNDS
Entity Type:Organization
Organization Name:CONVENIENT ULTRASOUNDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAICHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-400-1401
Mailing Address - Street 1:10822 LANTERN VIEW DR APT 307
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4204
Mailing Address - Country:US
Mailing Address - Phone:916-216-4410
Mailing Address - Fax:
Practice Address - Street 1:10822 LANTERN VIEW DR APT 307
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4204
Practice Address - Country:US
Practice Address - Phone:916-216-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-08
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile