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General NPI Number Information
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NPI Number | 1093868432
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Entity Type | Organization
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Legal Business Name | RIVERSIDE CYTOLOGY LABORATORY, INC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 516 MAIN ST SUITE B
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City | TELL CITY
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State | IN
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Zip | 47586-2211
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Country | US
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Telephone | 812-548-0521
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Fax | 812-548-0521
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Provider Business Mailing Address
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Address Line | 516 MAIN ST SUITE B
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City | TELL CITY
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State | IN
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Zip | 47586-2211
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Country | US
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Telephone | 812-548-0521
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Fax | 812-548-0521
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC J DAUM
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Credential |
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Telephone | 812-548-0521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 15D1022101
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License Number State | IN
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