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General NPI Number Information
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NPI Number | 1205545860
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Entity Type | Organization
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Legal Business Name | PROVIDENCE SURGERY AND PROCEDURE CENTER LLC
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 16528 E DESMET CT
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-3522
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Country | US
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Telephone | 509-944-8960
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Fax |
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Provider Business Mailing Address
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Address Line | 16528 E DESMET CT STE A2100
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-3522
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Country | US
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Telephone | 509-944-8960
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Fax |
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | JONATHAN BAILEY
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Credential |
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Telephone | 203-609-1168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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