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General NPI Number Information
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NPI Number | 1083372890
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Entity Type | Organization
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Legal Business Name | EAGLE ROCK MEDICAL CENTER LLC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 919 S UTAH AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3322
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Country | US
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Telephone | 208-425-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 919 S UTAH AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3322
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Country | US
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Telephone | 208-425-6020
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KENDON HOWARD
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Credential |
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Telephone | 208-972-0420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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