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General NPI Number Information
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NPI Number | 1326232315
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Entity Type | Organization
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Legal Business Name | ULTRA DIAGNOSTIC IMAGING, INC
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Dates
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Enumeration Date | 09/01/2007
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Last Update Date | 09/01/2007
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Provider Practice Location Address
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Address Line | 3687 TAMPA RD SUITE 202
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City | OLDSMAR
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State | FL
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Zip | 34677-6307
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Country | US
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Telephone | 813-925-3343
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Fax | 813-854-2929
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Provider Business Mailing Address
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Address Line | 3945 WELLINGTON PKWY
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City | PALM HARBOR
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State | FL
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Zip | 34685-1172
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Country | US
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Telephone | 215-760-0766
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN MARK MITCHELL
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Credential | D.O.
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Telephone | 215-760-0766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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