Provider Demographics
NPI:1588896591
Name:TREASURE COAST ULTRASOUND CONSULTANTS, INC
Entity type:Organization
Organization Name:TREASURE COAST ULTRASOUND CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RADIOLOGIC TECHNOLOG
Authorized Official - Phone:239-591-5995
Mailing Address - Street 1:850 CENTRAL AVE
Mailing Address - Street 2:#305
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6030
Mailing Address - Country:US
Mailing Address - Phone:239-571-5995
Mailing Address - Fax:239-775-6661
Practice Address - Street 1:850 CENTRAL AVE
Practice Address - Street 2:#305
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6030
Practice Address - Country:US
Practice Address - Phone:239-571-5995
Practice Address - Fax:239-775-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14776ARDMS261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile