Provider Demographics
NPI:1083668552
Name:ULTRASOUND SPECIALTIES, LLC
Entity Type:Organization
Organization Name:ULTRASOUND SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:928-242-4154
Mailing Address - Street 1:P O BOX 1584
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902
Mailing Address - Country:US
Mailing Address - Phone:928-532-0535
Mailing Address - Fax:928-523-0537
Practice Address - Street 1:3051 S WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE D
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7435
Practice Address - Country:US
Practice Address - Phone:928-532-0535
Practice Address - Fax:928-532-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41660261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ021007Medicaid
AZZ107760Medicare PIN