Provider Demographics
NPI:1891122503
Name:UNIVERSAL IMAGING SERVICES LLC
Entity Type:Organization
Organization Name:UNIVERSAL IMAGING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSOG
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R)
Authorized Official - Phone:443-235-4991
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0041
Mailing Address - Country:US
Mailing Address - Phone:765-284-0493
Mailing Address - Fax:765-284-2434
Practice Address - Street 1:13154 COIT RD
Practice Address - Street 2:#202
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5773
Practice Address - Country:US
Practice Address - Phone:443-235-4991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty