Provider Demographics
NPI:1437457769
Name:DIAGNOSTIC MEDICAL ULTRASOUND SERVICE, LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC MEDICAL ULTRASOUND SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, ABD,OB/GYN/RVT
Authorized Official - Phone:636-248-2073
Mailing Address - Street 1:3819 RIDGEFIELD FARMS DR
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63341-2009
Mailing Address - Country:US
Mailing Address - Phone:636-248-2073
Mailing Address - Fax:
Practice Address - Street 1:3819 RIDGEFIELD FARMS DR
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:MO
Practice Address - Zip Code:63341-2009
Practice Address - Country:US
Practice Address - Phone:636-248-2073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14095246XS1301X, 2471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty