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General NPI Number Information
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NPI Number | 1225214661
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Entity Type | Organization
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Legal Business Name | MON VALLEY DIALYSIS CLINIC, INC.
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 1051 COUNTRY CLUB RD
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City | MONONGAHELA
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State | PA
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Zip | 15063-1553
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Country | US
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Telephone | 724-258-9552
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Fax | 724-258-9553
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Provider Business Mailing Address
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Address Line | 1051 COUNTRY CLUB RD
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City | MONONGAHELA
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State | PA
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Zip | 15063-1553
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Country | US
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Telephone | 724-258-9552
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Fax | 724-258-9553
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Authorized Official
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Title or Position | OWNER, CEO
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Name | DR. SUBRAMONIAM JAYAKUMAR
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Credential | MD
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Telephone | 724-258-9552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD035880L
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License Number State | PA
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