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General NPI Number Information
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NPI Number | 1316473168
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Entity Type | Organization
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Legal Business Name | HIGH POWER DIAGNOSIS
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 2200 N PONCE DE LEON BLVD SUITE 7
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-2600
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Country | US
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Telephone | 904-580-6120
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 WINDJAMMER LN
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-5248
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Country | US
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Telephone | 904-580-6120
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT A HOLLINGTON
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Credential | M.D.
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Telephone | 904-580-6120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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