Provider Demographics
NPI:1730680489
Name:SPEED OF LIGHT ULTRASOUND, LLC
Entity Type:Organization
Organization Name:SPEED OF LIGHT ULTRASOUND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MAGNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-363-9583
Mailing Address - Street 1:3200 TROUP HWY STE 130
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8330
Mailing Address - Country:US
Mailing Address - Phone:903-363-9583
Mailing Address - Fax:903-617-6208
Practice Address - Street 1:3200 TROUP HWY STE 130
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8330
Practice Address - Country:US
Practice Address - Phone:903-363-9583
Practice Address - Fax:903-617-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP02172702OtherRAILROAD