Provider Demographics
NPI:1619109162
Name:MOBILE ULTRASOUND IMAGING, LLC
Entity Type:Organization
Organization Name:MOBILE ULTRASOUND IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT, MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNDSAY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:321-777-4545
Mailing Address - Street 1:233 E NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4571
Mailing Address - Country:US
Mailing Address - Phone:321-777-4545
Mailing Address - Fax:321-777-4565
Practice Address - Street 1:233 E NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4571
Practice Address - Country:US
Practice Address - Phone:321-777-4545
Practice Address - Fax:321-777-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile