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General NPI Number Information
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NPI Number | 1629378310
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Entity Type | Organization
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Legal Business Name | GERICARE CENTER LLC
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 7539 SPRING HILL DR
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City | SPRING HILL
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State | FL
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Zip | 34606-4350
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Country | US
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Telephone | 352-666-0790
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Fax | 352-666-0903
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Provider Business Mailing Address
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Address Line | 7539 SPRING HILL DR
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City | SPRING HILL
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State | FL
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Zip | 34606-4350
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Country | US
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Telephone | 352-666-0790
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Fax | 352-666-0903
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JIMMY EDMOND
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Credential | M.D.
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Telephone | 352-666-0790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME81127
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License Number State | FL
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