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General NPI Number Information
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NPI Number | 1245779180
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Entity Type | Organization
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Legal Business Name | AT MEDICAL DME
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 45 E CITY LINE AVE PMB 535
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City | BALA CYNWYD
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State | PA
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Zip | 19004-2421
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Country | US
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Telephone | 610-724-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 45 E CITY LINE AVE PMB 535
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City | BALA CYNWYD
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State | PA
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Zip | 19004-2421
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Country | US
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Telephone | 610-724-3561
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | MR. MICHAEL KEITH KEENE JR.
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Credential | BOCO
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Telephone | 610-724-3561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | OH000301
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License Number State | PA
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