Provider Demographics
NPI:1598286148
Name:ROADRUNNER ULTRASOUND EQUIPMENT, LLC
Entity Type:Organization
Organization Name:ROADRUNNER ULTRASOUND EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:JACK
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT (RT)
Authorized Official - Phone:866-972-9786
Mailing Address - Street 1:150 SETTLEMENT DR STE D
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-9662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 SETTLEMENT DR STE D
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-9662
Practice Address - Country:US
Practice Address - Phone:866-972-9786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROADRUNNER RADIOLOGY EQUIPMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-05
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory