Provider Demographics
NPI:1154069813
Name:SEDONA DIAGNOSTIC ULTRASOUND LLC
Entity Type:Organization
Organization Name:SEDONA DIAGNOSTIC ULTRASOUND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHILALI
Authorized Official - Middle Name:
Authorized Official - Last Name:VIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT
Authorized Official - Phone:928-275-2588
Mailing Address - Street 1:PO BOX 4537
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86340-4537
Mailing Address - Country:US
Mailing Address - Phone:928-275-2588
Mailing Address - Fax:
Practice Address - Street 1:415 INSPIRATIONAL DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5611
Practice Address - Country:US
Practice Address - Phone:928-275-2588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile