Provider Demographics
NPI:1467549121
Name:ULTRA IMAGING, LLC
Entity Type:Organization
Organization Name:ULTRA IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-223-0303
Mailing Address - Street 1:2014 LITHO PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2518
Mailing Address - Country:US
Mailing Address - Phone:910-223-0303
Mailing Address - Fax:
Practice Address - Street 1:2014 LITHO PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2518
Practice Address - Country:US
Practice Address - Phone:910-223-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7926713OtherAETNA
NC0195QOtherBCBS
NC7011254OtherCIGNA
NC28927OtherWELLPATH