Provider Demographics
NPI:1093769655
Name:PIQUE ULTRASOUND IMAGING SERVICES, LLC
Entity Type:Organization
Organization Name:PIQUE ULTRASOUND IMAGING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SONOGRAPHER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RYBAK
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS, RVT, RDMS
Authorized Official - Phone:239-810-4419
Mailing Address - Street 1:1301 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-3367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:239-369-7279
Practice Address - Street 1:1301 E 9TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-3367
Practice Address - Country:US
Practice Address - Phone:239-810-4419
Practice Address - Fax:239-369-7279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6873261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service