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General NPI Number Information
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NPI Number | 1497035364
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Entity Type | Organization
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Legal Business Name | ULTIMATE CARE MEDICAL CENTER
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 3898 VIA POINCIANA SUITE #18
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City | LAKE WORTH
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State | FL
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Zip | 33467-2951
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Country | US
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Telephone | 561-969-2112
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Fax | 561-641-3113
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Provider Business Mailing Address
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Address Line | 3898 VIA POINCIANA SUITE #18
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City | LAKE WORTH
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State | FL
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Zip | 33467-2951
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Country | US
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Telephone | 561-969-2112
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Fax | 561-641-3113
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Authorized Official
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Title or Position | ARNP OWNER
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Name | BERNADINE C HENRY
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Credential | ARNP
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Telephone | 561-969-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 9205733
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License Number State | FL
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