Provider Demographics
NPI:1821495060
Name:PURE IMAGE MOBILE ULTRASOUND
Entity Type:Organization
Organization Name:PURE IMAGE MOBILE ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ULTRASOUND
Authorized Official - Prefix:
Authorized Official - First Name:QUANESHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-251-5978
Mailing Address - Street 1:1820 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-5203
Mailing Address - Country:US
Mailing Address - Phone:928-276-4917
Mailing Address - Fax:928-504-6003
Practice Address - Street 1:1820 W 17TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-5203
Practice Address - Country:US
Practice Address - Phone:928-276-4917
Practice Address - Fax:928-504-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251G00000XAgenciesHospice Care, Community Based