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General NPI Number Information
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NPI Number | 1730730144
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Entity Type | Organization
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Legal Business Name | MODESTO MOBILE IMAGING SERVICES
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 5021 ROSSO CT
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City | SALIDA
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State | CA
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Zip | 95368-9066
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Country | US
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Telephone | 209-855-6900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3091
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City | MODESTO
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State | CA
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Zip | 95353-3091
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Country | US
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Telephone | 209-575-4575
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Fax | 209-575-4598
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Authorized Official
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Title or Position | MANAGER
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Name | JAMIE DOLE
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Credential |
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Telephone | 209-575-4575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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