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General NPI Number Information
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NPI Number | 1477900710
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Entity Type | Organization
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Legal Business Name | BJOSC, LLC
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 1767 PARK AVE STE 300
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City | PLOVER
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State | WI
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Zip | 54467-4301
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Country | US
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Telephone | 715-359-6442
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Fax | 715-393-0390
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Provider Business Mailing Address
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Address Line | 1767 PARK AVE STE 300
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City | PLOVER
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State | WI
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Zip | 54467-4301
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Country | US
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Telephone | 715-344-1260
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Fax | 715-393-0390
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Authorized Official
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Title or Position | PRESIDENT
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Name | BENJAMIN J HACKETT
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Credential | MD
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Telephone | 715-393-0334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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