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General NPI Number Information
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NPI Number | 1437440518
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Entity Type | Organization
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Legal Business Name | FUSHION MEDICAL
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 15349 DAVENPORT CIR
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City | OMAHA
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State | NE
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Zip | 68154-2043
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Country | US
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Telephone | 402-505-4670
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Fax |
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Provider Business Mailing Address
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Address Line | 55 YATES ST
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City | FORTY FORT
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State | PA
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Zip | 18704-4118
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Country | US
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Telephone | 570-690-0623
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Fax |
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Authorized Official
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Title or Position | COTA/L
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Name | MRS. AMY B KUPSTAS
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Credential |
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Telephone | 570-690-0623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | OP006778
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License Number State | PA
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