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General NPI Number Information
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NPI Number | 1144578436
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Entity Type | Organization
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Legal Business Name | SOUTHERN OHIO MEDICAL CENTER
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Dates
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Enumeration Date | 08/17/2012
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Last Update Date | 08/17/2012
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Provider Practice Location Address
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Address Line | 1805 27TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2640
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Country | US
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Telephone | 740-353-1105
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Fax |
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Provider Business Mailing Address
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Address Line | 1248 KINNEYS LN
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2927
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Country | US
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Telephone | 740-353-1105
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. DEAN WRAY
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Credential |
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Telephone | 740-356-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State | OH
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