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General NPI Number Information
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NPI Number | 1043362916
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Entity Type | Organization
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Legal Business Name | PRESTIGE IMAGING, LLC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 4780 N JOSEY LN
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City | CARROLLTON
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State | TX
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Zip | 75010-4615
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Country | US
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Telephone | 972-492-1334
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Fax | 972-492-7909
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Provider Business Mailing Address
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Address Line | 106 HYDE PARK BLVD SUITE 102
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City | CLEBURNE
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State | TX
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Zip | 76033-4523
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Country | US
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Telephone | 817-558-1940
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Fax | 817-558-1960
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Authorized Official
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Title or Position | FACILITY DIRECTOR
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Name | MS. KIM D CRUZ
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Credential | LVN
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Telephone | 817-558-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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