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General NPI Number Information
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NPI Number | 1124073960
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC RADIOLOGY SYSTEMS
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2425 REGENCY RD
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City | LEXINGTON
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State | KY
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Zip | 40503-2948
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Country | US
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Telephone | 859-275-2100
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Fax | 859-275-1159
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Provider Business Mailing Address
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Address Line | 601 W SHORT ST
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City | LEXINGTON
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State | KY
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Zip | 40508-1246
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Country | US
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Telephone | 859-231-7644
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Fax | 859-233-7644
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRUCE MANOR
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Credential |
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Telephone | 859-231-7644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 730053
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License Number State | KY
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