Provider Demographics
NPI:1558508705
Name:MIDWEST MOBILE ULTRASOUND
Entity Type:Organization
Organization Name:MIDWEST MOBILE ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-425-4681
Mailing Address - Street 1:1031 MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-8226
Mailing Address - Country:US
Mailing Address - Phone:812-425-4681
Mailing Address - Fax:812-425-2564
Practice Address - Street 1:245 W ROOSEVELT RD
Practice Address - Street 2:UNIT 77 BUILDING 11
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3739
Practice Address - Country:US
Practice Address - Phone:630-293-8718
Practice Address - Fax:630-293-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile