Provider Demographics
NPI:1619076189
Name:CMB ULTRASOUND INC
Entity Type:Organization
Organization Name:CMB ULTRASOUND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORGES
Authorized Official - Suffix:
Authorized Official - Credentials:ARDMS, RDCS, RVT
Authorized Official - Phone:305-451-4110
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070
Mailing Address - Country:US
Mailing Address - Phone:305-451-4110
Mailing Address - Fax:305-453-2920
Practice Address - Street 1:103400 OVERSEAS HWY
Practice Address - Street 2:SUITE 240
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2834
Practice Address - Country:US
Practice Address - Phone:305-451-4110
Practice Address - Fax:305-453-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5883261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1723Medicare ID - Type Unspecified