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General NPI Number Information
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NPI Number | 1356586762
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Entity Type | Organization
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Legal Business Name | PIONEER MEDICAL, LLC
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Dates
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Enumeration Date | 12/14/2008
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Last Update Date | 12/14/2008
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Provider Practice Location Address
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Address Line | 100 CLARENDON AVE
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City | PETAL
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State | MS
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Zip | 39465-2636
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Country | US
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Telephone | 866-951-9727
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 512
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City | PETAL
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State | MS
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Zip | 39465-0512
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Country | US
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Telephone | 800-951-9729
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRAD H MASSEY
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Credential |
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Telephone | 800-951-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State | MS
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