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General NPI Number Information
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NPI Number | 1982875217
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Entity Type | Organization
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Legal Business Name | MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 3716 UNIVERSITY BLVD S STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4318
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Country | US
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Telephone | 904-446-9093
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Fax | 904-446-9095
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Provider Business Mailing Address
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Address Line | PO BOX 5606
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City | JACKSONVILLE
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State | FL
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Zip | 32247-5606
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Country | US
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Telephone | 904-446-9093
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Fax | 904-446-9095
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | KEESHA COMPTON
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Credential |
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Telephone | 904-731-1556
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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 | FL
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