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General NPI Number Information
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NPI Number | 1518314665
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Entity Type | Organization
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Legal Business Name | WESTERN INTEGRATED MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 10609 N HAYDEN RD SUITE E 106
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-8531
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Country | US
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Telephone | 480-315-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 10869 N SCOTTSDALE RD SUITE 103-153
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5280
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Country | US
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Telephone | 480-315-1141
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHARLES ANDERSON
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Credential |
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Telephone | 480-315-1141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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