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General NPI Number Information
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NPI Number | 1053626168
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Entity Type | Organization
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Legal Business Name | VITAE CLINIC INC
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 1600 W 38TH ST SUITE 115
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City | AUSTIN
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State | TX
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Zip | 78731-6400
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Country | US
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Telephone | 512-458-6060
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Fax | 512-458-6070
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Provider Business Mailing Address
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Address Line | PO BOX 301990 3507 N. LAMAR
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City | AUSTIN
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State | TX
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Zip | 78703-0034
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Country | US
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Telephone | 512-458-6060
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Fax | 512-458-6070
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Authorized Official
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Title or Position | PHYSICIAN/MEDICAL DIRECTOR
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Name | DR. JEREMY ANDREW KALAMARIDES
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Credential | DO
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Telephone | 512-458-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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