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General NPI Number Information
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NPI Number | 1578936787
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Entity Type | Organization
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Legal Business Name | VIDADYNE HEALTHCARE LLC
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 14820 N CAVE CREEK RD STE 2
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City | PHOENIX
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State | AZ
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Zip | 85032-4953
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Country | US
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Telephone | 480-646-3478
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Fax | 480-712-4695
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Provider Business Mailing Address
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Address Line | 14820 N CAVE CREEK RD STE 2
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City | PHOENIX
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State | AZ
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Zip | 85032-4953
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Country | US
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Telephone | 480-646-3478
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Fax | 480-712-4695
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. PAUL WILLIAM JENNER
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Credential | M.D.
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Telephone | 480-201-6167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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