Provider Demographics
NPI:1265761506
Name:SONO CARE OF EAST TEXAS LLC
Entity type:Organization
Organization Name:SONO CARE OF EAST TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SONOGRAPHER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:ARDMS/RVT
Authorized Official - Phone:903-520-3232
Mailing Address - Street 1:625 CHASE DR STE 106
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9452
Mailing Address - Country:US
Mailing Address - Phone:903-520-3232
Mailing Address - Fax:903-705-7353
Practice Address - Street 1:625 CHASE DR STE 106
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9452
Practice Address - Country:US
Practice Address - Phone:903-520-3232
Practice Address - Fax:903-705-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX810472471S1302X
TX318782471V0105X, 261QR0208X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTUV18Medicare Oscar/Certification