Provider Demographics
NPI:1114312659
Name:UNITED SHOCKWAVE SERVICES, LTD.
Entity Type:Organization
Organization Name:UNITED SHOCKWAVE SERVICES, LTD.
Other - Org Name:UNITED THERAPIES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FBRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-544-5853
Mailing Address - Street 1:PO BOX 2178
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60017-2178
Mailing Address - Country:US
Mailing Address - Phone:877-465-4845
Mailing Address - Fax:847-297-8853
Practice Address - Street 1:1720 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3855
Practice Address - Country:US
Practice Address - Phone:877-465-4845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED SHOCKWAVE SERVICES, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3514261QA1903X
261QL0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy