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General NPI Number Information
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NPI Number | 1275994477
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Entity Type | Organization
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Legal Business Name | OPTIMUM DIAGNOSTIC IMAGING CENTER
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 1300 S BRYAN RD STE 104
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City | MISSION
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State | TX
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Zip | 78572-6688
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Country | US
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Telephone | 956-583-0004
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Fax | 956-583-5790
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Provider Business Mailing Address
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Address Line | 1300 S BRYAN RD STE 104
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City | MISSION
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State | TX
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Zip | 78572-6626
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Country | US
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Telephone | 956-583-0004
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Fax | 956-583-5790
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | IVAN REMACHE
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Credential |
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Telephone | 956-583-0004
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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 | R41088
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License Number State | TX
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