Provider Demographics
NPI:1265989172
Name:CDA ULTRASOUND, INC.
Entity type:Organization
Organization Name:CDA ULTRASOUND, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT
Authorized Official - Phone:208-771-3882
Mailing Address - Street 1:2201 N GOVERNMENT WAY
Mailing Address - Street 2:SUITE J
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3658
Mailing Address - Country:US
Mailing Address - Phone:208-261-2520
Mailing Address - Fax:
Practice Address - Street 1:2201 N GOVERNMENT WAY
Practice Address - Street 2:SUITE J
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3658
Practice Address - Country:US
Practice Address - Phone:208-261-2520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYARDMS793412471S1302X
CAARDMS524762471V0105X, 2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty