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General NPI Number Information
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NPI Number | 1619792215
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Entity Type | Organization
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Legal Business Name | CCRM FLORIDA SURGERY LLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 19505 BISCAYNE BLVD STE 2230
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City | MIAMI
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State | FL
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Zip | 33180-3644
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Country | US
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Telephone | 305-526-4530
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Fax | 833-983-0045
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Provider Business Mailing Address
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Address Line | 9380 STATION ST STE 425
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City | LONE TREE
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State | CO
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Zip | 80124-6832
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF MANAGED CARE OFFICER
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Name | DIANE JEAN RAVECH
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Credential |
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Telephone | 860-305-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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