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General NPI Number Information
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NPI Number | 1275606253
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Entity Type | Organization
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Legal Business Name | SSMRI LLC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5501 WILLOW CREEK DR SUITE 200
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City | SPRINGDALE
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State | AR
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Zip | 72762-8704
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Country | US
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Telephone | 479-442-4553
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Fax | 479-251-1006
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Provider Business Mailing Address
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Address Line | 108 CROSSOVER AVE SUITE E
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City | LOWELL
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State | AR
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Zip | 72745-8937
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Country | US
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Telephone | 479-770-6333
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Fax | 479-770-8033
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Authorized Official
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Title or Position | RADIOLOGIST
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Name | DR. DAN M RINER
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Credential | M.D.
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Telephone | 479-770-6333
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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 | C4750
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License Number State | AR
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