Basic Information
| Provider Information | |||||||||
| NPI: | 1891122503 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSAL IMAGING SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 41 | ||||||||
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| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473080041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652840493 | ||||||||
| FaxNumber: | 7652842434 | ||||||||
| Practice Location | |||||||||
| Address1: | 13154 COIT RD | ||||||||
| Address2: | #202 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752405773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4432354991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2013 | ||||||||
| LastUpdateDate: | 08/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | MUSSOG | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4432354991 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RT (R) | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist |
No ID Information.