Provider Demographics
NPI:1720588080
Name:US SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:US SPORTS MEDICINE, LLC
Other - Org Name:RAYUS RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL ASSISTANT SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:AHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-738-4441
Mailing Address - Street 1:PO BOX 741804
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-1804
Mailing Address - Country:US
Mailing Address - Phone:866-674-7933
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:1982 W. PLEASANT GROVE BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062
Practice Address - Country:US
Practice Address - Phone:801-563-0333
Practice Address - Fax:801-563-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty