Provider Demographics
NPI:1093846263
Name:ULTRASOUND AND ECHO CARDIOGRAM MEDICAL DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:ULTRASOUND AND ECHO CARDIOGRAM MEDICAL DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-637-0348
Mailing Address - Street 1:109 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1421
Mailing Address - Country:US
Mailing Address - Phone:330-637-0348
Mailing Address - Fax:330-637-0048
Practice Address - Street 1:5594 STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003-0179
Practice Address - Country:US
Practice Address - Phone:440-293-2444
Practice Address - Fax:440-293-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9348051Medicaid
OH9348051Medicaid