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General NPI Number Information
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NPI Number | 1457655748
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Entity Type | Organization
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Legal Business Name | MELRICH INC
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Dates
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Enumeration Date | 12/31/2010
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Last Update Date | 12/31/2010
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Provider Practice Location Address
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Address Line | 625 CANNONBURY DR
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City | SAINT LOUIS
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State | MO
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Zip | 63119-5312
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Country | US
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Telephone | 314-395-3656
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Fax |
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Provider Business Mailing Address
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Address Line | 625 CANNONBURY DR
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City | SAINT LOUIS
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State | MO
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Zip | 63119-5312
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Country | US
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Telephone | 314-395-3656
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | DR. RICHARD JAMES STORK
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Credential | MD
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Telephone | 31439536356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 2008006962
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License Number State | MO
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