Provider Demographics
NPI:1982842845
Name:PRECIOUS IMAGES ULTRASOUND, LLC
Entity Type:Organization
Organization Name:PRECIOUS IMAGES ULTRASOUND, LLC
Other - Org Name:SBT DIAGNOSTIC CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:ADOLPHINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-869-0866
Mailing Address - Street 1:1006 TOP ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7642
Mailing Address - Country:US
Mailing Address - Phone:601-869-0866
Mailing Address - Fax:601-869-0877
Practice Address - Street 1:1006 TOP STREET
Practice Address - Street 2:SUITE H
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7643
Practice Address - Country:US
Practice Address - Phone:601-869-0866
Practice Address - Fax:601-869-0877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECIOUS IMAGES ULTRASOUND, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-30
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00978841Medicaid
539251Medicare PIN