Provider Demographics
NPI:1114231305
Name:IMAGING MIRACLES LC
Entity Type:Organization
Organization Name:IMAGING MIRACLES LC
Other - Org Name:ADVANCED ULTRASOUND SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RDCS
Authorized Official - Phone:417-861-0071
Mailing Address - Street 1:3827 S TIMBERCREEK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5685
Mailing Address - Country:US
Mailing Address - Phone:417-861-0071
Mailing Address - Fax:
Practice Address - Street 1:3827 S TIMBERCREEK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5685
Practice Address - Country:US
Practice Address - Phone:417-861-0071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:20100328
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1048492261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center