Provider Demographics
NPI:1407113517
Name:MOBILE ULTRASOUND LLC
Entity Type:Organization
Organization Name:MOBILE ULTRASOUND LLC
Other - Org Name:MOBILE ULTRASOUND OF KANSAS CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BRANCH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-920-6970
Mailing Address - Street 1:3319 N ELSTON AVE
Mailing Address - Street 2:SUITE 252
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5811
Mailing Address - Country:US
Mailing Address - Phone:816-920-6970
Mailing Address - Fax:816-994-0083
Practice Address - Street 1:6501 E COMMERCE AVE
Practice Address - Street 2:SUITE 170A
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64120-2171
Practice Address - Country:US
Practice Address - Phone:816-920-6970
Practice Address - Fax:816-994-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4213Medicare PIN