Provider Demographics
NPI:1013081058
Name:BOBODZHANOV INC
Entity Type:Organization
Organization Name:BOBODZHANOV INC
Other - Org Name:ULTRAECHO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBODZHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RDCS
Authorized Official - Phone:206-621-4722
Mailing Address - Street 1:440 W BRODERICK DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6427
Mailing Address - Country:US
Mailing Address - Phone:206-786-6936
Mailing Address - Fax:206-621-4176
Practice Address - Street 1:440 W BRODERICK DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6427
Practice Address - Country:US
Practice Address - Phone:206-786-6936
Practice Address - Fax:206-621-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246XS1301X, 2471S1302X, 2471V0105X
WAN/A PORTABLE U/S335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0185002OtherLABOR AND INDUSTRIES
WA7130BOOtherREGENCE
WA47001664OtherRAILROAD MEDICARE
WA7115389Medicaid
WA568397002OtherGROUP HEALTH COOPERATIVE
WA568397002OtherGROUP HEALTH COOPERATIVE
WA=========OtherCIGNA
WAGAB28391Medicare PIN
WA0185002OtherLABOR AND INDUSTRIES
WA=========OtherCIGNA