Provider Demographics
NPI:1548219025
Name:SONOWAVE INC.
Entity Type:Organization
Organization Name:SONOWAVE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-531-9740
Mailing Address - Street 1:PO BOX 120131
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75712-0131
Mailing Address - Country:US
Mailing Address - Phone:903-531-9740
Mailing Address - Fax:903-531-9764
Practice Address - Street 1:417 S CHILTON AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8017
Practice Address - Country:US
Practice Address - Phone:903-531-9740
Practice Address - Fax:903-531-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088143501Medicaid
TXFTCVU2Medicare PIN