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General NPI Number Information
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NPI Number | 1063737369
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Entity Type | Organization
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Legal Business Name | VA MEDICAL CENTER
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 2900 VETERANS WAY
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City | VIERA
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State | FL
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Zip | 32940
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Country | US
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Telephone | 321-637-3688
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Fax | 321-637-3677
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Provider Business Mailing Address
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Address Line | 2900 VETERANS WAY
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City | VIERA
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State | FL
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Zip | 32940
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Country | US
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Telephone | 321-637-3688
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Fax | 321-637-3677
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Authorized Official
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Title or Position | HUD/VASH CASE MANAGER
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Name | MR. JASON DEAN HOPPENBROUWER
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Credential | LCSW
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Telephone | 321-637-3654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | SW5603
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License Number State | FL
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