Basic Information
| Provider Information | |||||||||
| NPI: | 1053604652 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HD ULTRASOUND, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MINT MEDICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 POST ST | ||||||||
| Address2: | SUITE 1001 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941084912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156716819 | ||||||||
| FaxNumber: | 5102179708 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 LINCOLN AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951263705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082887705 | ||||||||
| FaxNumber: | 5102179708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2011 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | HUMMEL | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4156716819 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.