Provider Demographics
NPI:1255824801
Name:REAL TIME INC
Entity Type:Organization
Organization Name:REAL TIME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SYDNAM RDMS RVT RT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-2158
Mailing Address - Street 1:1700 E BOGARD RD STE A200
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6569
Mailing Address - Country:US
Mailing Address - Phone:907-357-2158
Mailing Address - Fax:907-357-5849
Practice Address - Street 1:1700 E BOGARD RD STE A200
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
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:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty