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General NPI Number Information
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NPI Number | 1164464707
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Entity Type | Organization
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Legal Business Name | PROMED INC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 1401 S BERETANIA ST SUITE 620
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City | HONOLULU
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State | HI
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Zip | 96814-1870
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Country | US
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Telephone | 808-396-1316
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Fax | 808-356-0391
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Provider Business Mailing Address
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Address Line | 27383 VIA INDUSTRIA SUITE 200
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City | TEMECULA
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State | CA
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Zip | 92590-3699
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Country | US
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Telephone | 808-396-1316
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Fax | 808-356-0391
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. CHRISTOPHER THIBODEAUX
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Credential | DME SUPPLIER
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Telephone | 844-633-6287
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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 |
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License Number State | HI
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