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General NPI Number Information
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NPI Number | 1386025914
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Entity Type | Organization
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Legal Business Name | REVERE HEALTHCARE SOLUTIONS, INC
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 302 FLEMING ST
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City | GARDEN CITY
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State | KS
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Zip | 67846-5972
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Country | US
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Telephone | 620-271-1424
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 W 83RD ST SUITE 151
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5472
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Country | US
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Telephone | 913-283-8223
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CARMINE DIPALO
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Credential |
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Telephone | 913-283-8223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7918758
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License Number State | KS
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