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General NPI Number Information
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NPI Number | 1386879922
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Entity Type | Organization
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Legal Business Name | OPTIMUM MEDICAL SERVICE LLC
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 409 S MISSOURI AVE
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City | WESLACO
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State | TX
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Zip | 78596-6017
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Country | US
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Telephone | 956-854-4134
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Fax |
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Provider Business Mailing Address
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Address Line | 409 S MISSOURI AVE
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City | WESLACO
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State | TX
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Zip | 78596-6017
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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 | DIRECTOR OF OPERATIONS
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Name | DORA PEREZ
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Credential |
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Telephone | 956-475-8978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1000248
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License Number State | TX
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