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General NPI Number Information
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NPI Number | 1881939874
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Entity Type | Organization
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Legal Business Name | EXTREMITY IMAGING CENTERS LLC
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 8962 E DESERT COVE DR # 125
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6984
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Country | US
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Telephone | 480-526-5440
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Fax | 480-990-9397
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Provider Business Mailing Address
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Address Line | 7301 E 2ND ST STE 202
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-5610
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Country | US
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Telephone | 480-994-5977
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Fax | 480-990-9397
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD PAUL JACOBY
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Credential | DPM
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Telephone | 480-994-5977
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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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Taxonomy #2
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | 1058929
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License Number State | AZ
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