Provider Demographics
NPI:1225218209
Name:REAL TIME II LLC
Entity Type:Organization
Organization Name:REAL TIME II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RDCS
Authorized Official - Phone:907-357-2158
Mailing Address - Street 1:1700 E BOGARD RD # 101
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6563
Mailing Address - Country:US
Mailing Address - Phone:907-357-2158
Mailing Address - Fax:907-357-5849
Practice Address - Street 1:1700 E BOGARD RD # 101
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6563
Practice Address - Country:US
Practice Address - Phone:907-357-2158
Practice Address - Fax:907-357-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK152269Medicare PIN