Provider Demographics
NPI:1275711426
Name:ULTRACARE DIAGNOSTICS
Entity Type:Organization
Organization Name:ULTRACARE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-391-3300
Mailing Address - Street 1:9808 N 95TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4608
Mailing Address - Country:US
Mailing Address - Phone:480-391-3300
Mailing Address - Fax:
Practice Address - Street 1:9808 N 95TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4608
Practice Address - Country:US
Practice Address - Phone:480-391-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology