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General NPI Number Information
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NPI Number | 1144325986
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Entity Type | Organization
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Legal Business Name | CERTIFIED MEDICAL SYSTEMS III INC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 2600 US HIGHWAY 1 S UNIT 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6199
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Country | US
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Telephone | 904-810-9747
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Fax | 904-810-9740
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Provider Business Mailing Address
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Address Line | 2600 US HIGHWAY 1 S UNIT 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6199
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Country | US
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Telephone | 904-810-9747
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Fax | 904-810-9740
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. MICHAEL DILLMAN
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Credential |
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Telephone | 904-272-3022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1678
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License Number State | FL
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