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General NPI Number Information
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NPI Number | 1871643601
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Entity Type | Organization
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Legal Business Name | MARSHALL RADIOLOGY SERVICE PC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 2305 S HIGHWAY 65
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City | MARSHALL
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State | MO
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Zip | 65340-3702
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Country | US
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Telephone | 660-831-3286
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1547
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City | SEDALIA
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State | MO
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Zip | 65302-1547
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Country | US
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Telephone | 660-826-5960
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Fax | 660-826-4852
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Authorized Official
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Title or Position | PRESIDENT
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Name | NORBERTO RESTITUTO
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Credential | M.D.
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Telephone | 660-831-3286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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