Provider Demographics
NPI:1245792704
Name:MYULTRASOUND DIAGNOSTIC IMAGING CENTERS, LLC
Entity Type:Organization
Organization Name:MYULTRASOUND DIAGNOSTIC IMAGING CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-932-9109
Mailing Address - Street 1:1816 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3116
Mailing Address - Country:US
Mailing Address - Phone:214-932-1909
Mailing Address - Fax:972-231-1753
Practice Address - Street 1:1816 WHITNEY DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3116
Practice Address - Country:US
Practice Address - Phone:214-932-9109
Practice Address - Fax:972-231-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile