Provider Demographics
NPI:1528379914
Name:SPORTS ULTRASOUND LLC
Entity Type:Organization
Organization Name:SPORTS ULTRASOUND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-424-5067
Mailing Address - Street 1:2259 WELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4118
Mailing Address - Country:US
Mailing Address - Phone:801-484-7254
Mailing Address - Fax:801-293-8618
Practice Address - Street 1:4888 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6007
Practice Address - Country:US
Practice Address - Phone:801-424-5067
Practice Address - Fax:801-293-8618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7523097-01602471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty