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General NPI Number Information
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NPI Number | 1346573839
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Entity Type | Organization
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Legal Business Name | ULTRACARE MOBILE DIAGNOSTIC IMAGING LLC
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 4181 IONA ST
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City | TITUSVILLE
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State | FL
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Zip | 32796-2222
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Country | US
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Telephone | 321-795-7396
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Fax | 321-225-4936
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Provider Business Mailing Address
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Address Line | 4181 IONA ST
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City | TITUSVILLE
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State | FL
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Zip | 32796-2222
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Country | US
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Telephone | 321-795-7396
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Fax | 321-225-4936
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MS. DEBORAH Y. HAZELBAKER
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Credential | RDMS
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Telephone | 321-795-7396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 57090
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 57090
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License Number State | FL
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