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General NPI Number Information
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NPI Number | 1194868984
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Entity Type | Organization
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Legal Business Name | MEDCARE DIABETIC SUPPLY LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 29 ENTERPRISE DR SUITE B
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City | BUNNELL
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State | FL
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Zip | 32110-4302
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Country | US
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Telephone | 386-206-4844
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Fax | 386-206-4413
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Provider Business Mailing Address
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Address Line | 29 ENTERPRISE DR SUITE B
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City | BUNNELL
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State | FL
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Zip | 32110-4302
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Country | US
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Telephone | 386-206-4844
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Fax | 386-206-4413
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Authorized Official
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Title or Position | GENERAL MANAGER-MGR.MEMBER
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Name | MS. CATHERINE MCVEIGH
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Credential |
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Telephone | 386-206-4844
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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 | 1312982
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License Number State | FL
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