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General NPI Number Information
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NPI Number | 1447210109
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Entity Type | Organization
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Legal Business Name | LECONTE RADIOLOGY PC
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 907 E LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37804-5015
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Country | US
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Telephone | 865-548-4004
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Fax | 865-980-4962
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Provider Business Mailing Address
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Address Line | PO BOX 1445
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-1445
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Country | US
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Telephone | 865-588-2928
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN G NIETHAMMER III
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Credential | MD
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Telephone | 865-548-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | TN
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