Provider Demographics
NPI:1285786749
Name:CAROLINA MOBILE ULTRASOUND, PLLC
Entity type:Organization
Organization Name:CAROLINA MOBILE ULTRASOUND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:FLEMING
Authorized Official - Last Name:HALLYBURTON
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:828-413-7117
Mailing Address - Street 1:2566 CAMAREIGH LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-9314
Mailing Address - Country:US
Mailing Address - Phone:828-413-7117
Mailing Address - Fax:
Practice Address - Street 1:2566 CAMAREIGH LN
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-9314
Practice Address - Country:US
Practice Address - Phone:828-413-7117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101091246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty