Provider Demographics
NPI:1538256797
Name:PROFESSIONAL MEDICAL ULTRASOUND INC
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL ULTRASOUND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-592-6345
Mailing Address - Street 1:1320 EATON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2831
Mailing Address - Country:US
Mailing Address - Phone:909-592-6345
Mailing Address - Fax:909-592-6156
Practice Address - Street 1:1320 EATON RD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2831
Practice Address - Country:US
Practice Address - Phone:909-592-6345
Practice Address - Fax:909-592-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID
CAZZZ16961ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER