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General NPI Number Information
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NPI Number | 1134407158
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Entity Type | Organization
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Legal Business Name | COLUMBUS VASCULAR CENTER, LLC
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 4519 WOODRUFF RD STE 17
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City | COLUMBUS
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State | GA
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Zip | 31904-6091
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Country | US
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Telephone | 706-221-8999
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Fax | 706-221-8809
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Provider Business Mailing Address
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Address Line | 3001 PALM HARBOR BLVD STE A
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City | PALM HARBOR
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State | FL
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Zip | 34683-1930
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Country | US
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Telephone | 727-474-0090
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Fax | 727-474-0055
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. JANET R DEES
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Credential |
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Telephone | 727-474-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 54214
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License Number State | GA
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