Provider Demographics
NPI:1417014952
Name:MOUNTAIN ULTRASOUND IMAGING, INC.
Entity Type:Organization
Organization Name:MOUNTAIN ULTRASOUND IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/SECT/TREAS.
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R), RDMS, RVT
Authorized Official - Phone:828-274-4567
Mailing Address - Street 1:1 VANDERBILT PARK DRIVE
Mailing Address - Street 2:240
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1736
Mailing Address - Country:US
Mailing Address - Phone:828-274-4567
Mailing Address - Fax:828-277-5600
Practice Address - Street 1:1 VANDERBILT PARK DRIVE
Practice Address - Street 2:240
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1736
Practice Address - Country:US
Practice Address - Phone:828-274-4567
Practice Address - Fax:828-277-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8105025Medicaid
NC2880167PTANMedicare UPIN