Provider Demographics
NPI:1174927891
Name:PURE IMAGE MOBILE ULTRASOUND GROUP LLC
Entity type:Organization
Organization Name:PURE IMAGE MOBILE ULTRASOUND GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ULTRASOUND TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-276-4917
Mailing Address - Street 1:2281 W 24TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6197
Mailing Address - Country:US
Mailing Address - Phone:928-276-4917
Mailing Address - Fax:928-504-6003
Practice Address - Street 1:2281 W 24TH ST STE 5
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6197
Practice Address - Country:US
Practice Address - Phone:928-276-4917
Practice Address - Fax:928-504-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty