Provider Demographics
NPI:1992783682
Name:PORTABLE ULTRASOUND OF UTAH LLC
Entity type:Organization
Organization Name:PORTABLE ULTRASOUND OF UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-645-2606
Mailing Address - Street 1:5538 DUNCAN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2812
Mailing Address - Country:US
Mailing Address - Phone:702-645-2606
Mailing Address - Fax:702-645-2874
Practice Address - Street 1:2212 S WEST TEMPLE
Practice Address - Street 2:STE 18
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2642
Practice Address - Country:US
Practice Address - Phone:801-359-2532
Practice Address - Fax:801-485-4174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00119284OtherRAIL ROAD MEDICARE
UTP00119284OtherRAIL ROAD MEDICARE
UT=========OtherCHAMPUS
UT=========001Medicaid