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General NPI Number Information
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NPI Number | 1306493366
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Entity Type | Organization
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Legal Business Name | KENRICK'S DEDICATED HOSPITALIST SERVICES
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 707 S EDWIN C MOSES BLVD
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City | DAYTON
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State | OH
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Zip | 45417-3462
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Country | US
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Telephone | 513-508-8945
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Fax | 513-494-3072
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Provider Business Mailing Address
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Address Line | 71 VISTA RIDGE DR
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City | SOUTH LEBANON
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State | OH
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Zip | 45065-8755
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Country | US
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Telephone | 513-508-8945
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENRICK RICHARDSON
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Credential | MD
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Telephone | 513-508-8945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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