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General NPI Number Information
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NPI Number | 1508142530
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Entity Type | Organization
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Legal Business Name | SUMMIT MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 8362 REDWOOD AVE #20
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City | FONTANA
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State | CA
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Zip | 92335-8058
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Country | US
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Telephone | 951-314-1771
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Fax |
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Provider Business Mailing Address
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Address Line | 10808 FOOTHILL BLVD SUITE 160-493
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3889
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Country | US
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Telephone | 951-314-1771
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MILA DAVIS
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Credential |
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Telephone | 951-314-1771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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