Provider Demographics
NPI:1558380592
Name:HD ULTRASOUND LLC
Entity Type:Organization
Organization Name:HD ULTRASOUND LLC
Other - Org Name:HEALTH DIAGNOSTICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-865-9670
Mailing Address - Street 1:44 MONTGOMERY ST
Mailing Address - Street 2:SUITE 1280
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4602
Mailing Address - Country:US
Mailing Address - Phone:510-865-9670
Mailing Address - Fax:510-865-9680
Practice Address - Street 1:625 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3705
Practice Address - Country:US
Practice Address - Phone:510-865-9670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ09153ZOtherBLUE SHIELD