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General NPI Number Information
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NPI Number | 1104800556
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Entity Type | Organization
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Legal Business Name | OLYMPIA MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 3933 HAVERHILL RD N SUITE 115
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-7424
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Country | US
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Telephone | 561-478-7659
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Fax | 561-478-7957
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Provider Business Mailing Address
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Address Line | 3933 N HAVERHILL RD STE 115
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-8338
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Country | US
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Telephone | 561-478-7659
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Fax | 877-317-6158
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Authorized Official
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Title or Position | OWNER
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Name | DR. RENES CASTOR
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Credential | MD
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Telephone | 561-478-7659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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