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General NPI Number Information
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NPI Number | 1427273440
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Entity Type | Organization
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Legal Business Name | ENDOSCOPY CENTER OF ST. LOUIS, LLC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 12990 MANCHESTER RD SUITE 1
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City | DES PERES
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State | MO
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Zip | 63131-1804
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Country | US
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Telephone | 314-984-0550
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Fax | 314-984-0501
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Provider Business Mailing Address
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Address Line | 200 BREVCO PLZ SUITE 207
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-2949
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Country | US
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Telephone | 636-561-5450
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Fax | 636-561-5451
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KIM ANN LAWSON
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Credential |
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Telephone | 636-561-5450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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