Basic Information
| Provider Information | |||||||||
| NPI: | 1558380592 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HD ULTRASOUND LLC | ||||||||
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| OtherOrganizationName: | HEALTH DIAGNOSTICS | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 MONTGOMERY ST | ||||||||
| Address2: | SUITE 1280 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941044602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108659670 | ||||||||
| FaxNumber: | 5108659680 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951263705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108659670 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUMMEL | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5108659670 | ||||||||
| 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 |
ID Information
| ID | Type | State | Issuer | Description | ZZZ09153Z | 01 | CA | BLUE SHIELD | OTHER |