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General NPI Number Information
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NPI Number | 1679764583
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Entity Type | Organization
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Legal Business Name | UNIVERSITY IMAGING CENTER, LLC
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 13 W ORMOND AVE
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City | CHERRY HILL
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State | NJ
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Zip | 08002-3041
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Country | US
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Telephone | 856-616-9400
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Fax | 856-616-9107
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Provider Business Mailing Address
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Address Line | PO BOX 1210A
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City | VINELAND
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State | NJ
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Zip | 08362-1210
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Country | US
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Telephone | 856-692-1198
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MS. LOUISE PERNELL
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Credential |
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Telephone | 856-692-1198
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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 | 22413
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License Number State | NJ
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