Provider Demographics
NPI:1760779011
Name:KELLY ULTRASOUND CENTER LLC
Entity Type:Organization
Organization Name:KELLY ULTRASOUND CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-234-1234
Mailing Address - Street 1:140 MILESTONE WAY
Mailing Address - Street 2:STE. B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5065
Mailing Address - Country:US
Mailing Address - Phone:864-234-1234
Mailing Address - Fax:
Practice Address - Street 1:140 MILESTONE WAY
Practice Address - Street 2:STE. B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5065
Practice Address - Country:US
Practice Address - Phone:864-234-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH460012471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty