Provider Demographics
NPI:1093175838
Name:PRECISION ULTRASOUND IMAGING INC.
Entity Type:Organization
Organization Name:PRECISION ULTRASOUND IMAGING INC.
Other - Org Name:PRECISION IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:BATES
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RT RDMS RVT
Authorized Official - Phone:601-573-0577
Mailing Address - Street 1:730 RIDGEWOOD RD STE B
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4434
Mailing Address - Country:US
Mailing Address - Phone:601-573-0577
Mailing Address - Fax:601-939-6775
Practice Address - Street 1:730 RIDGEWOOD RD STE B
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4434
Practice Address - Country:US
Practice Address - Phone:601-573-0577
Practice Address - Fax:601-939-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25X0009816335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302G638831Medicare PIN