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General NPI Number Information
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NPI Number | 1710948708
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Entity Type | Organization
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Legal Business Name | NEW SMYRNA IMAGING, LLC
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 405 E 3RD AVE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-3129
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Country | US
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Telephone | 386-426-1900
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Fax | 386-426-5939
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Provider Business Mailing Address
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Address Line | 405 E 3RD AVE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-3129
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Country | US
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Telephone | 386-426-1900
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Fax | 386-426-5939
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Authorized Official
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Title or Position | COO
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Name | TRACI L.W. POSTELL
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Credential | CPCS, CHBME
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Telephone | 386-426-1900
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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 |
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License Number State |
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