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General NPI Number Information
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NPI Number | 1104141118
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Entity Type | Organization
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Legal Business Name | ALLERGY SPECIALTY CARE PA
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 213 SW MAIN BLVD
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City | LAKE CITY
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State | FL
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Zip | 32025-7001
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Country | US
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Telephone | 386-961-9809
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Fax | 386-961-8311
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Provider Business Mailing Address
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Address Line | 213 SW MAIN BLVD
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City | LAKE CITY
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State | FL
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Zip | 32025-7001
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Country | US
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Telephone | 386-961-9809
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Fax | 386-961-8311
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Authorized Official
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Title or Position | INSURANCE BILLING MANAGER
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Name | MRS. DENISE CONE
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Credential |
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Telephone | 386-961-9809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PA2020
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License Number State | FL
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