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General NPI Number Information
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NPI Number | 1205377595
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Entity Type | Organization
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Legal Business Name | VALANT ANESTHESIA SERVICES LLC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 10521 SW VILLAGE CENTER DR SUITE 104
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-1930
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Country | US
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Telephone | 772-345-8602
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Fax | 772-345-8605
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Provider Business Mailing Address
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Address Line | PO BOX 740485
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City | ATLANTA
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State | GA
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Zip | 30374-0485
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Country | US
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Telephone | 941-360-1566
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Fax | 941-358-9818
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Authorized Official
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Title or Position | MEMBER
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Name | MARK I. EISENFELD
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Credential | MD
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Telephone | 941-360-1566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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