Provider Demographics
NPI:1467487066
Name:FORT LAUDERDALE MOBILE ULTRASOUND INC
Entity Type:Organization
Organization Name:FORT LAUDERDALE MOBILE ULTRASOUND INC
Other - Org Name:DPI OF PLANTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEKKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-566-4551
Mailing Address - Street 1:PO BOX 5286
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33310-5286
Mailing Address - Country:US
Mailing Address - Phone:954-566-4551
Mailing Address - Fax:954-566-4565
Practice Address - Street 1:7301 NW 4TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2234
Practice Address - Country:US
Practice Address - Phone:954-566-4551
Practice Address - Fax:954-566-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0889591OtherAETNA
FLV2156OtherBLUE CROSS BLUE SHIELD
FLV2156OtherBLUE CROSS BLUE SHIELD