Provider Demographics
NPI:1336151554
Name:WAVES ADVANCED ULTRASOUND
Entity Type:Organization
Organization Name:WAVES ADVANCED ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MROZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-899-4998
Mailing Address - Street 1:2200 HERITAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2326
Mailing Address - Country:US
Mailing Address - Phone:319-832-2229
Mailing Address - Fax:800-426-4536
Practice Address - Street 1:2200 HERITAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2326
Practice Address - Country:US
Practice Address - Phone:319-832-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology