Provider Demographics
NPI:1194765610
Name:ADVANCED ULTRASOUND DIAGNOSTICS, INC,
Entity type:Organization
Organization Name:ADVANCED ULTRASOUND DIAGNOSTICS, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-226-0583
Mailing Address - Street 1:720 N COMMERCE ST
Mailing Address - Street 2:#226
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3915
Mailing Address - Country:US
Mailing Address - Phone:580-223-4770
Mailing Address - Fax:580-223-4899
Practice Address - Street 1:720 N COMMERCE ST
Practice Address - Street 2:#226
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3915
Practice Address - Country:US
Practice Address - Phone:580-223-4770
Practice Address - Fax:580-223-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========-001OtherBCBS