Provider Demographics
NPI:1346658556
Name:ULTRASOUND INSTITUTE MEDICAL GROUP
Entity Type:Organization
Organization Name:ULTRASOUND INSTITUTE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-483-5550
Mailing Address - Street 1:3700 INLAND EMPIRE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4906
Mailing Address - Country:US
Mailing Address - Phone:909-483-5550
Mailing Address - Fax:909-483-5509
Practice Address - Street 1:3700 INLAND EMPIRE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4906
Practice Address - Country:US
Practice Address - Phone:909-483-5550
Practice Address - Fax:909-483-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty