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General NPI Number Information
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NPI Number | 1255943767
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Entity Type | Organization
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Legal Business Name | VIVERANT INTEGRATIVE CLINIC LLC
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 335 SPRING ST STE B
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-4480
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Country | US
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Telephone | 812-255-1699
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Fax |
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Provider Business Mailing Address
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Address Line | 300 SPRING ST STE 3B
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3498
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Country | US
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Telephone | 812-255-1699
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JO LEIGH HOLLAND
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Credential |
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Telephone | 812-255-1699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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