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NPI Code Detail

MEDICARE: EDWARD BRADLEY VINSON CNIM

MEDICARE:   EDWARD BRADLEY VINSON  CNIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZE0600XElectroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number : 1508388695
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD BRADLEY VINSON CNIM
Provider Business Mailing Address
First Line : PO BOX 845
Second Line :
City : LOWELL
State : AR
Zip : 72745-0845
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3497 WAGON WHEEL RD
Second Line :
City : SPRINGDALE
State : AR
Zip : 72762-0115
Country : US
Telephone Number : 877-295-2554
Fax Number : 877-295-2554
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2017
Last Update Date : 07/11/2017

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Directions to “ EDWARD BRADLEY VINSON CNIM” Practice Location

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