Provider Demographics
NPI:1790352912
Name:DEGA ULTRASOUND, LLC
Entity Type:Organization
Organization Name:DEGA ULTRASOUND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD TECH/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:JANICE
Authorized Official - Last Name:JOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:207-768-1479
Mailing Address - Street 1:PO BOX 111307
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-1307
Mailing Address - Country:US
Mailing Address - Phone:207-768-1479
Mailing Address - Fax:
Practice Address - Street 1:3322 COLORADO BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6889
Practice Address - Country:US
Practice Address - Phone:950-566-6666
Practice Address - Fax:940-387-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty