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General NPI Number Information
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NPI Number | 1417229329
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL MEDICAL ULTRASONICS INC.
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 4089 WEBSTER RD SUITE 5
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City | SUMMERSVILLE
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State | WV
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Zip | 26651
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Country | US
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Telephone | 304-872-8396
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Fax |
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Provider Business Mailing Address
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Address Line | 202 CARRIAGE DR
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City | BECKELY
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State | WV
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Zip | 25801-2806
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Country | US
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Telephone | 304-252-0609
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ANGEL ROSAS
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Credential | MD
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Telephone | 304-252-0609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 2012003732
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License Number State | WV
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