Provider Demographics
NPI:1790056802
Name:ULTRASOUND INSTITUTE MEDICAL GROUP
Entity Type:Organization
Organization Name:ULTRASOUND INSTITUTE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-497-3572
Mailing Address - Street 1:8618 N 35TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-3800
Mailing Address - Country:US
Mailing Address - Phone:602-354-5677
Mailing Address - Fax:602-354-7257
Practice Address - Street 1:8618 N 35TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3800
Practice Address - Country:US
Practice Address - Phone:310-497-3572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty