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General NPI Number Information
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NPI Number | 1952334070
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC IMAGING CENTER LLC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 1901 W LUGONIA AVE SUITE 110
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City | REDLANDS
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State | CA
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Zip | 92374
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Country | US
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Telephone | 909-557-1690
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Fax | 909-557-1735
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Provider Business Mailing Address
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Address Line | PO BOX 8820
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City | REDLANDS
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State | CA
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Zip | 92375-2020
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Country | US
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Telephone | 909-557-1690
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Fax | 909-557-1735
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | BARRY GRAMES
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Credential | MD
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Telephone | 909-557-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ZZZ31558Z
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License Number State | CA
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