Provider Demographics
NPI:1114312659
Name:UNITED SHOCKWAVE SERVICES, LTD.
Entity type:Organization
Organization Name:UNITED SHOCKWAVE SERVICES, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-544-5853
Mailing Address - Street 1:PO BOX 95439
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76099-9735
Mailing Address - Country:US
Mailing Address - Phone:877-465-4845
Mailing Address - Fax:847-297-8853
Practice Address - Street 1:1990 STEAM WAY STE A102
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2233
Practice Address - Country:US
Practice Address - Phone:877-465-4845
Practice Address - Fax:847-544-5955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED SHOCKWAVE SERVICES, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-01
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QL0400X
NM3514261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy