Provider Demographics
NPI:1124006721
Name:ULTRASOUND DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:ULTRASOUND DIAGNOSTIC SERVICES
Other - Org Name:DIAGNOSTIC HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-242-8500
Mailing Address - Street 1:5055 KELLER SPRINGS RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5997
Mailing Address - Country:US
Mailing Address - Phone:214-242-8500
Mailing Address - Fax:
Practice Address - Street 1:7998 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 108
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4904
Practice Address - Country:US
Practice Address - Phone:623-878-5650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 3819261QR0200X
261QR0208X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC 3819OtherAZ STATE LICENSE
AZ025133Medicaid
AZOTC 3819OtherAZ STATE LICENSE