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General NPI Number Information
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NPI Number | 1114452877
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Entity Type | Organization
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Legal Business Name | MANDALA MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 5000 CEDAR PLAZA PKWY STE 220
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3854
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Country | US
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Telephone | 314-845-9010
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Fax | 314-845-6399
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Provider Business Mailing Address
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Address Line | 5000 CEDAR PLAZA PKWY STE 220
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3854
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Country | US
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Telephone | 314-845-9010
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Fax | 314-845-6399
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA S. HOFFMANN
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Credential | MD
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Telephone | 314-845-9010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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