Provider Demographics
NPI:1750406807
Name:MOBILE ECHOCARDIOGRAPHY INC
Entity type:Organization
Organization Name:MOBILE ECHOCARDIOGRAPHY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:801-541-5225
Mailing Address - Street 1:PO BOX 571421
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-1421
Mailing Address - Country:US
Mailing Address - Phone:801-541-5225
Mailing Address - Fax:801-265-2234
Practice Address - Street 1:4914 SO STONE CREST DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-541-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTARDMS132536246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT000009147Medicare PIN