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General NPI Number Information
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NPI Number | 1174893770
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Entity Type | Organization
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Legal Business Name | MONTGOMERY RADIATION CENTER LLC
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 644 MAYSVILLE RD STE 10-B
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City | MOUNT STERLING
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State | KY
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Zip | 40353-9464
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Country | US
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Telephone | 606-571-0300
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Fax | 740-566-4642
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Provider Business Mailing Address
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Address Line | PO BOX 1326
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City | ASHLAND
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State | KY
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Zip | 41105-1326
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Country | US
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Telephone | 606-571-0300
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Fax | 740-566-4642
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Authorized Official
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Title or Position | PHYSICIAN
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Name | AARON ORLANDO WILLIAMS
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Credential | MD
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Telephone | 606-571-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35341
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License Number State | KY
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