Provider Demographics
NPI:1578507810
Name:ULTRA S IMAGING LC
Entity Type:Organization
Organization Name:ULTRA S IMAGING LC
Other - Org Name:U/S IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RTR
Authorized Official - Phone:989-345-0527
Mailing Address - Street 1:231 RUBY CT
Mailing Address - Street 2:#4
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1165
Mailing Address - Country:US
Mailing Address - Phone:989-345-0527
Mailing Address - Fax:
Practice Address - Street 1:231 RUBY CT
Practice Address - Street 2:#4
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1165
Practice Address - Country:US
Practice Address - Phone:989-345-0527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty