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General NPI Number Information
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NPI Number | 1215255609
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Entity Type | Organization
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Legal Business Name | OMEGA CHOICE INC
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 05/10/2010
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Provider Practice Location Address
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Address Line | 2250 N CORAL CANYON BLVD STE 102
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City | WASHINGTON
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State | UT
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Zip | 84780-2649
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Country | US
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Telephone | 435-216-2184
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Fax |
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Provider Business Mailing Address
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Address Line | 9030 W SAHARA AVE STE 406
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City | LAS VEGAS
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State | NV
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Zip | 89117-5744
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Country | US
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Telephone | 435-216-2184
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RALPHA D WADE
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Credential | D.O.
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Telephone | 435-216-2184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 180211-1204
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License Number State | UT
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