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General NPI Number Information
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NPI Number | 1629336193
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Entity Type | Organization
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Legal Business Name | SAR MEDICAL INSTITUTE LLC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 2811 TAMIAMI TRL STE Q
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 941-979-5200
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Fax | 941-979-5201
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Provider Business Mailing Address
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Address Line | PO BOX 380877
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City | MURDOCK
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State | FL
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Zip | 33938-0877
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Country | US
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Telephone | 941-979-5200
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Fax | 941-979-5201
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | STEPHEN MARK ROSS
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Credential | MD,PH.D.
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Telephone | 941-979-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | PMC1756
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License Number State | FL
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