Provider Demographics
NPI:1861738304
Name:MOBILE ULTRASOUND LLC
Entity type:Organization
Organization Name:MOBILE ULTRASOUND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BRANCH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-272-4161
Mailing Address - Street 1:3319 N ELSTON AVE
Mailing Address - Street 2:SUITE 252
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5811
Mailing Address - Country:US
Mailing Address - Phone:314-272-4161
Mailing Address - Fax:
Practice Address - Street 1:10016 OFFICE CENTER AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1468
Practice Address - Country:US
Practice Address - Phone:314-272-4161
Practice Address - Fax:314-735-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty