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General NPI Number Information
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NPI Number | 1699175158
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Entity Type | Organization
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Legal Business Name | ALLIED IMAGING INC
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 11/02/2017
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Provider Practice Location Address
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Address Line | 2043 E CENTER ST STE 115
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City | POCATELLO
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State | ID
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Zip | 83201-3300
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Country | US
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Telephone | 208-904-0498
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Fax |
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Provider Business Mailing Address
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Address Line | 2043 E CENTER ST STE 115
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City | POCATELLO
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State | ID
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Zip | 83201-3300
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Country | US
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Telephone | 208-904-0498
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | RANAE DAVISON
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Credential |
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Telephone | 208-539-9923
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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 | 154319
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License Number State | CA
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