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General NPI Number Information
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NPI Number | 1093862054
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Entity Type | Organization
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Legal Business Name | PROSTHETIC CENTER OF INDIANA, LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 321 E WINSLOW RD
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City | BLOOMINGTON
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State | IN
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Zip | 47401-8648
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Country | US
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Telephone | 812-332-5347
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Fax | 812-323-2939
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Provider Business Mailing Address
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Address Line | 321 E WINSLOW RD
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City | BLOOMINGTON
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State | IN
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Zip | 47401-8648
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Country | US
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Telephone | 812-332-5347
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Fax | 812-323-2939
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES WILLIAM DEWEES
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Credential | C.P.
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Telephone | 812-332-5347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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