Provider Demographics
NPI:1326033960
Name:SONOLOGICS LLC
Entity Type:Organization
Organization Name:SONOLOGICS LLC
Other - Org Name:INSIGHT IMAGING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:WINBURN
Authorized Official - Last Name:MOUNTCASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-525-7005
Mailing Address - Street 1:1901 ROXBOROUGH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3482
Mailing Address - Country:US
Mailing Address - Phone:813-933-6848
Mailing Address - Fax:813-933-7767
Practice Address - Street 1:2835 W DE LEON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4130
Practice Address - Country:US
Practice Address - Phone:813-872-6170
Practice Address - Fax:813-872-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4797AMedicare PIN