Provider Demographics
NPI:1760531958
Name:PROFESSIONAL ULTRASOUND IMAGING, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL ULTRASOUND IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-849-8700
Mailing Address - Street 1:3501 TOKEN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-9709
Mailing Address - Country:US
Mailing Address - Phone:817-849-8700
Mailing Address - Fax:817-849-8701
Practice Address - Street 1:3501 TOKEN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-9709
Practice Address - Country:US
Practice Address - Phone:817-849-8700
Practice Address - Fax:817-849-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1448342-01Medicaid
TX4241HMOtherBLUE CROSS BLUE SHIELD
TX4241HMOtherBLUE CROSS BLUE SHIELD