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General NPI Number Information
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NPI Number | 1215036421
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Entity Type | Organization
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Legal Business Name | PREMIER DIAGNOSTIC IMAGING SERVICES LLC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/07/2007
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Provider Practice Location Address
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Address Line | 3595 W 20TH AVE SUITE 145
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City | HIALEAH
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State | FL
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Zip | 33012-4533
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Country | US
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Telephone | 305-820-1455
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Fax | 305-820-1485
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Provider Business Mailing Address
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Address Line | 3595 W 20TH AVE SUITE 145
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City | HIALEAH
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State | FL
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Zip | 33012-4533
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Country | US
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Telephone | 305-820-1455
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Fax | 305-820-1485
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAUL E MENESES
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Credential |
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Telephone | 305-467-4448
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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 |
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License Number State |
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