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General NPI Number Information
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NPI Number | 1588855027
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Entity Type | Organization
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Legal Business Name | PHYSICIANS IMAGING -- LAKE CITY LLC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 404 NW HALL OF FAME DR
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City | LAKE CITY
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State | FL
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Zip | 32055-4833
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Country | US
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Telephone | 386-487-3970
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Fax | 386-487-3972
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Provider Business Mailing Address
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Address Line | 404 NW HALL OF FAME DR
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City | LAKE CITY
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State | FL
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Zip | 32055-4833
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Country | US
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Telephone | 386-487-3970
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Fax | 386-487-3972
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Authorized Official
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Title or Position | CEO
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Name | DR. ELIAS J GERTH
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Credential | MD
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Telephone | 352-383-8800
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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 | HCC7889
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License Number State | FL
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