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General NPI Number Information
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NPI Number | 1417108093
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Entity Type | Organization
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Legal Business Name | J.R. MEDICAL CENTER, CORP.
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 5700 MONROE ST SUITE: #120-379
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City | SYLVANIA
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State | OH
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Zip | 43560-2767
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Country | US
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Telephone | 419-490-5771
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Fax |
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Provider Business Mailing Address
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Address Line | 427 W DUSSEL DR SUITE# 336
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City | MAUMEE
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State | OH
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Zip | 43537-4208
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Country | US
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Telephone | 419-490-5771
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSE CARLOS RIOS BETANCOURT
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Credential |
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Telephone | 419-490-5771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | OH
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