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General NPI Number Information
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NPI Number | 1538375936
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Entity Type | Organization
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Legal Business Name | ROSE MED DIAGNOSTIC CENTER INC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 1235 N KROME AVE SUITE R
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City | HOMESTEAD
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State | FL
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Zip | 33030-4204
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Country | US
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Telephone | 305-242-1160
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Fax | 305-242-1161
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Provider Business Mailing Address
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Address Line | 1235 N KROME AVE SUITE R
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City | HOMESTEAD
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State | FL
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Zip | 33030-4204
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Country | US
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Telephone | 305-242-1160
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Fax | 305-242-1161
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Authorized Official
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Title or Position | PRESIDENT
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Name | NILDA R ACOSTA
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Credential | MD
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Telephone | 305-242-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | HCC2775
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License Number State | FL
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