Provider Demographics
NPI:1417229329
Name:PROFESSIONAL MEDICAL ULTRASONICS INC.
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL ULTRASONICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-252-0609
Mailing Address - Street 1:202 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:BECKELY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2806
Mailing Address - Country:US
Mailing Address - Phone:304-252-0609
Mailing Address - Fax:
Practice Address - Street 1:4089 WEBSTER RD SUITE 5
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651
Practice Address - Country:US
Practice Address - Phone:304-872-8396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2012003732261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9926301Medicare PIN