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General NPI Number Information
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NPI Number | 1316682354
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Entity Type | Organization
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Legal Business Name | WESTERN HEALTHCARE SERVICES INDIANA LLC
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 4011 S MONROE MEDICAL PARK BLVD
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City | BLOOMINGTON
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State | IN
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Zip | 47403-8000
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Country | US
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Telephone | 812-825-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 4932 SUNBEAM RD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6128
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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 | OWNER
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Name | DAVID M DAVIS III
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Credential |
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Telephone | 469-364-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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