Provider Demographics
NPI:1346202561
Name:CARDIAC ULTRASOUND, INC
Entity Type:Organization
Organization Name:CARDIAC ULTRASOUND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RCS
Authorized Official - Phone:570-489-0171
Mailing Address - Street 1:631 SANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:THROOP
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1255
Mailing Address - Country:US
Mailing Address - Phone:570-489-0171
Mailing Address - Fax:570-489-0185
Practice Address - Street 1:631 SANDERSON ST
Practice Address - Street 2:
Practice Address - City:THROOP
Practice Address - State:PA
Practice Address - Zip Code:18512-1255
Practice Address - Country:US
Practice Address - Phone:570-489-0171
Practice Address - Fax:570-489-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014789030001Medicaid
PAPB0213OtherUNISOM MEDPLUS
PA028062600OtherBLACK LUNG
PAP00376787Medicare PIN
PA020537Medicare PIN