Provider Demographics
NPI:1326232315
Name:ULTRA DIAGNOSTIC IMAGING, INC
Entity Type:Organization
Organization Name:ULTRA DIAGNOSTIC IMAGING, INC
Other - Org Name:ULTRA DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-760-0766
Mailing Address - Street 1:3945 WELLINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1172
Mailing Address - Country:US
Mailing Address - Phone:215-760-0766
Mailing Address - Fax:
Practice Address - Street 1:3687 TAMPA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-6307
Practice Address - Country:US
Practice Address - Phone:813-925-3343
Practice Address - Fax:813-854-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-01
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty