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General NPI Number Information
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NPI Number | 1215320726
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Entity Type | Organization
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Legal Business Name | WESTSTAR MEDICAL, LLC
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Dates
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Enumeration Date | 03/08/2015
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Last Update Date | 03/08/2015
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Provider Practice Location Address
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Address Line | 9015 E VIA LINDA SUITE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5410
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Country | US
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Telephone | 800-717-6390
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Fax | 800-717-6390
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Provider Business Mailing Address
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Address Line | 53444 ASH RD
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City | GRANGER
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State | IN
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Zip | 46530-5025
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. MARK A SMITH
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Credential | EDD
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Telephone | 800-717-6390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 03D2085583
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License Number State | AZ
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