Provider Demographics
NPI:1417975863
Name:GENERAL ULTRA SOUND IMAGING CENTER LLC
Entity Type:Organization
Organization Name:GENERAL ULTRA SOUND IMAGING CENTER LLC
Other - Org Name:GUIC LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO OF GUIC LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:S
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-728-7677
Mailing Address - Street 1:PO BOX 1802
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-4802
Mailing Address - Country:US
Mailing Address - Phone:931-728-7677
Mailing Address - Fax:931-728-7066
Practice Address - Street 1:1400 WILLOW DRIVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355
Practice Address - Country:US
Practice Address - Phone:931-728-7677
Practice Address - Fax:931-728-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732548Medicaid
TN4115812OtherBLUE CROSS BLUE SHIELD
TN4115812OtherBLUE CROSS BLUE SHIELD