Provider Demographics
NPI:1689821217
Name:KIMBERLY A BURCH
Entity Type:Organization
Organization Name:KIMBERLY A BURCH
Other - Org Name:IDEAL ULTASOUNDS SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-392-4169
Mailing Address - Street 1:5833 AEDC RD
Mailing Address - Street 2:
Mailing Address - City:ESTILL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37330-3915
Mailing Address - Country:US
Mailing Address - Phone:931-392-4169
Mailing Address - Fax:931-392-4187
Practice Address - Street 1:5833 AEDC RD
Practice Address - Street 2:
Practice Address - City:ESTILL SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37330-3915
Practice Address - Country:US
Practice Address - Phone:931-392-4169
Practice Address - Fax:931-392-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier