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General NPI Number Information
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NPI Number | 1013004043
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Entity Type | Organization
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Legal Business Name | HEMODIALYSIS ASSOC PC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 3335 S CRATER RD
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City | PETERSBURY
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State | VA
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Zip | 23805
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Country | US
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Telephone | 804-862-5261
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Fax |
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Provider Business Mailing Address
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Address Line | 425 SANDHURST DR
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City | PETERSBURG
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State | VA
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Zip | 23805-7862
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Country | US
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Telephone | 804-861-9555
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Fax | 804-861-9555
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FREDERICK IVAN ENDE
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Credential | MD
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Telephone | 804-861-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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