Provider Demographics
NPI:1710982384
Name:ULTRASOUND DIAGNOSTIC SERVICES, INC
Entity Type:Organization
Organization Name:ULTRASOUND DIAGNOSTIC SERVICES, INC
Other - Org Name:DIAGNOSTIC HEALTH SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-242-8500
Mailing Address - Street 1:7998 W. THUNDERBIRD RD.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4904
Mailing Address - Country:US
Mailing Address - Phone:623-878-5650
Mailing Address - Fax:623-878-5670
Practice Address - Street 1:7998 W. THUNDERBIRD RD.
Practice Address - Street 2:SUITE 108
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4904
Practice Address - Country:US
Practice Address - Phone:623-878-5650
Practice Address - Fax:623-878-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 3451261QR0200X
261QR0208X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ141911Medicaid
AZAZ0048450OtherBCBS OF AZ
AZOTC 3451OtherSTATE LICENSE
AZ470000852Medicare PIN
AZZ25352Medicare PIN