Provider Demographics
NPI:1255672333
Name:ULTRA HEALTHCARE SERVICES, INC
Entity type:Organization
Organization Name:ULTRA HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DAMIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-669-5525
Mailing Address - Street 1:21913 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2342
Mailing Address - Country:US
Mailing Address - Phone:727-669-5525
Mailing Address - Fax:727-669-8589
Practice Address - Street 1:21913 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2342
Practice Address - Country:US
Practice Address - Phone:727-669-5525
Practice Address - Fax:727-669-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5325261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIG924AMedicare PIN
FL630000499Medicare PIN
FLW9864Medicare PIN
FL0713200001Medicare NSC