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General NPI Number Information
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NPI Number | 1619066016
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Entity Type | Organization
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Legal Business Name | LIMB CARE CENTRE, LLC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 1301 PLANTATION ISLAND DR SUITE 203A
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City | ST. AUGUSTINE
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State | FL
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Zip | 32080
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Country | US
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Telephone | 904-461-0821
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Fax | 904-461-0823
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Provider Business Mailing Address
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Address Line | 1301 PLANTATION ISLAND DR SUITE 203A
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City | ST. AUGUSTINE
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State | FL
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Zip | 32080
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Country | US
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Telephone | 904-461-0821
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Fax | 904-461-0823
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Authorized Official
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Title or Position | OWNER
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Name | RYAN J PEREIRA
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Credential | DPM
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Telephone | 904-461-0821
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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 |
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License Number State |
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