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General NPI Number Information
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NPI Number | 1053665786
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Entity Type | Organization
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Legal Business Name | TEAMHEALTH PROVENA MERCY HOSPITAL
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 1325 N HIGHLAND AVE
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City | AURORA
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State | IL
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Zip | 60506-1449
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Country | US
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Telephone | 630-859-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 1 TRANSAM PLAZA DR SUITE 360
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-4822
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Country | US
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Telephone | 630-785-9100
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Fax | 630-785-9199
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MRS. MEGAN AMELIO
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Credential |
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Telephone | 630-785-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 085004497
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License Number State | IL
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