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General NPI Number Information
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NPI Number | 1225606296
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Entity Type | Organization
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Legal Business Name | EAST CENTRAL FLORIDA OUTPATIENT IMAGING LLC
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 5440 S. WILLIAMSON BLVD SUITE 102
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City | PORT ORANGE
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State | FL
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Zip | 32128
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Country | US
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Telephone | 386-274-7118
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Fax | 386-274-6173
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Provider Business Mailing Address
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Address Line | PO BOX 678454
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City | DALLAS
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State | TX
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Zip | 75267-8454
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AL FALCO
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Credential |
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Telephone | 386-274-7118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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